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

Definitions
Citation: Rev. Stat. §§ 222.005; 600.020(1); Admin. Regs. Tit. 922, 1:330

The term 'substance use disorder' means a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. Criteria for substance use disorder are in the most current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

The term 'abused or neglected child' means a child whose health or welfare is harmed or threatened with harm when their parent, guardian, or person in a position of authority or special trust engages in a pattern of conduct that renders the parent incapable of caring for the immediate and ongoing needs of the child, including, but not limited to, parental incapacity due to a substance use disorder as defined in § 222.005.

In regulation: The term 'assessment' means the collection and analysis of information to determine the strengths and needs of a family in order to provide appropriate services.

Notification/Reporting Requirements
Citation: Rev. Stat. §§ 214.160; 211.676

The Cabinet for Health and Family Services shall, as often as necessary, publish a list of the five most frequently abused substances, including alcohol, by pregnant women in the Commonwealth. Any physician and any other person legally permitted to engage in attendance upon a pregnant woman in this State may perform a screening for alcohol or substance dependency or abuse, including a comprehensive history of such behavior. Any physician may administer a toxicology test to a pregnant woman under the physician's care within 8 hours after delivery to determine whether there is evidence that she has ingested alcohol, a controlled substance, or a substance identified on the list provided by the cabinet or if the woman has obstetrical complications that are a medical indication of possible use of any such substance for a nonmedical purpose.

Any physician or person legally permitted to engage in attendance upon a pregnant woman may administer to each newborn infant born under that person's care a toxicology test to determine whether there is evidence of prenatal exposure to alcohol, a controlled substance, or a substance identified on the list provided by the cabinet if the attending person has reason to believe, based on a medical assessment of the mother or the infant, that the mother used any such substance for a nonmedical purpose during the pregnancy.

The circumstances surrounding any positive toxicology finding shall be evaluated by the attending person to determine if abuse or neglect of the infant, as defined under § 600.020, shall be reported to the State's child protective services agency. An infant affected by substance abuse withdrawal symptoms resulting from prenatal drug exposure or fetal alcohol spectrum disorder shall be reported to the State's child protective services agency in accordance with 42 U.S.C. § 5106a.

No prenatal screening for alcohol or other substance abuse or positive toxicology finding shall be used as prosecutorial evidence. No person shall conduct or cause to be conducted any toxicological test pursuant to this section on any pregnant woman without first informing the pregnant woman of the purpose of the test.

All cases of neonatal abstinence syndrome (NAS) diagnosed among Kentucky resident births shall be reported to the Kentucky Department for Public Health by the facility where NAS is diagnosed. The report shall be made at the time of NAS diagnosis pursuant to guidance issued by the department.

Assessment of the Infant and Family
Citation: Admin. Regs. Tit. 922, 1:330, § 2(4)(b)8

The cabinet shall investigate or conduct an assessment upon receipt of a report that alleges neglect of a child perpetrated by a caregiver that may result in harm to the health and safety of a child who is at risk of harm if the child is born exposed to drugs or alcohol, as documented by a health-care provider.

Responsibility for Development of the Plan of Safe Care
Citation: Admin. Regs. Tit. 922, 1:330, §§ 13; 14

The cabinet may develop a plan for services at any point during an investigation or assessment to protect the health and safety of a child. The planning shall proceed as follows: 

• The plan shall be developed in conjunction with a family and the family's identified support system.
• It shall be agreed upon by the participants.
• It shall be signed by all parties identified to participate in the plan unless a party is unwilling or unable to sign.
• A copy shall be provided to all participants.

If an investigation or assessment is conducted as a result of a child being referred pursuant to § 2(4)(b)8. of this administrative regulation, the cabinet shall develop a plan of safe care in accordance with 42 U.S.C. § 5106a(b)(2)(B)(iii).

Services for the Infant

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

Services for the Parents or Other Caregivers
Citation: Rev. Stat. § 218A.274; Admin. Regs. Tit. 908, § 1:374(11)

Substance abuse treatment or recovery service providers that receive State funding shall give pregnant women priority in accessing services and shall not refuse access to services solely due to pregnancy, as long as the provider's services are appropriate for pregnant women.

In regulation: If the medical director, program physician, or program prescriber of a narcotic treatment program (NTP) does not accept the responsibility for providing prenatal care for the term of the patient's pregnancy, then the medical director, program physician, or program prescriber shall refer the patient to either a primary care physician who practices obstetrics or an obstetrician.

The medical director, program physician, or program prescriber shall also do the following:

• Inform the prescriber accepting the referral of the patient's participation in the NTP
• Ensure that appropriate arrangements have been made for the medical care of both the patient and the child following the birth of the child
• Notify the pregnant patient's primary care physician or obstetrician of any changes in the patient's treatment

The program shall ensure that the following services are available for pregnant individuals and are a part of the treatment plan:

• Nutritional counseling
• Parenting training that includes information about the following:
  • Newborn care
  • Handling a newborn
  • Newborn health
  • Newborn safety

Monitoring Plans of Safe Care

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