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

Definitions
Citation: Children's Code Art. 603

The term 'prenatal neglect' means exposure to chronic or severe use of alcohol or the unlawful use of any controlled dangerous substance, or in a manner not lawfully prescribed, which results in symptoms of withdrawal in the newborn; or the presence of a controlled substance or a metabolic thereof in their body, blood, urine, or meconium that is not the result of medical treatment; or observable and harmful effects in their physical appearance or functioning.

Notification/Reporting Requirements
Citation: Children's Code Art. 610(G); Rev. Stat. § 40:1086.11

If a physician has cause to believe that a newborn was exposed in utero to an unlawfully used controlled dangerous substance, the physician shall order a toxicology test upon the newborn, without the consent of the newborn's parents or guardian, to determine whether there is evidence of prenatal neglect. If the test results are positive, the physician shall issue a report as soon as possible, in accordance with this article. If the test results are negative, all identifying information shall be obliterated if the record is retained unless the parent approves the inclusion of identifying information. Positive test results shall not be admissible in a criminal prosecution.

If there are symptoms of withdrawal in the newborn or other observable and harmful effects in their physical appearance or functioning that a physician has cause to believe are due to the chronic or severe use of alcohol by the mother during pregnancy or are the effects of fetal alcohol spectrum disorder, the physician shall issue a report in accordance with this article.

If a newborn exhibits symptoms of withdrawal or other observable and harmful effects in their physical appearance or functioning that a physician believes are due to the use of a controlled dangerous substance in a lawfully prescribed manner by the mother during pregnancy, the physician shall make a notification to the Department of Children and Family Services on a form developed by the department. Such notification shall not constitute a report of child abuse or prenatal neglect, nor shall it require prosecution for any illegal action.

A health-care provider shall be authorized to share any protected health information with the department for the purpose of complying with the notification requirement of this subpart.

The department shall promulgate rules and regulations in accordance with the Administrative Procedure Act to implement the provisions of this subpart. Such rules shall include, at minimum, all the following:

• The manner in which the notification shall be made to the department
• The form and minimum required contents of the notification
• The plan to monitor the statewide system regarding the availability and delivery of appropriate services for newborns and affected families and caregivers

Assessment of the Infant and Family
Citation: DSS Pol. Man. § 4-518(II)(D), (F)(4)

In policy: The worker shall obtain the following information from the hospital medical staff:

• Verification of evidence supporting prenatal neglect, including the following:
  • Results of mother's and infant's toxicology tests, if completed
  • Whether the infant has exhibited withdrawal symptoms or other observable and harmful effects in their physical appearance or functioning
• The current condition of the infant, including symptoms of withdrawal or any diagnosis of fetal alcohol syndrome or neonatal abstinence syndrome
• Their observations of the mother's behavior, including bonding behavior or interest in the baby
• Any visits with the mother or infant by the infant's father, family, and friends, along with their observations of the interaction between these persons and the infant

The interview with the mother (as well as later interviews with other professionals and any other caregivers) shall include obtaining as much information as possible about the mother's substance use, including both drugs and alcohol and any previous or current substance abuse treatment. The worker must conduct a minimum of two face-to-face contacts with the infant's mother. The initial contact may be shortly after the delivery of the infant. One additional contact is required so that the worker can ensure that a thorough assessment is completed and educational or referral information can be discussed at a time when the mother is not overwhelmed with the newness of an infant. The additional contact should be in the home so that interaction between the mother and infant can be observed. This will provide an opportunity to conduct a thorough assessment, assess safe sleep implementation, and complete any additional referrals needed. The exploration of the mother's plan for herself and her infant shall include information about the infant's father and their current relationship, his interest, and other caregivers available to assist her.

The investigation contacts shall include an interview with the infant's father to determine his potential involvement in the infant's care and his knowledge regarding the mother's substance use during pregnancy. If he resides in the home or may be involved in the care of the infant, he shall be assessed to obtain information regarding his use of drugs or alcohol. When substance use is indicated, the father shall be referred for a substance abuse assessment or services.

Important factors to consider when assessing safety involving substance-exposed newborns include the following: 

• The mother's acknowledgment or lack of acknowledgment of substance abuse issues
• The mother's prior agency and substance abuse history
• The mother's behavior and interaction or bonding with the newborn
• The family's support system
• The family's level of cooperation with the agency
• The home environment (including necessary newborn items and safe sleep)
• Mental health issues or the presence of domestic violence
• Assessment of all other adults and children living in the home

To ensure that a plan of safe care (POSC) addresses the needs of the substance-exposed newborn and the family, an assessment must be made to determine if a referral to family services is needed.

Responsibility for Development of the Plan of Safe Care
Citation: DSS Pol. Man. § 4-518(I), (II)(F)(1)-(2)

It is the policy of the Department of Children and Family Services (DCFS) to investigate reports of prenatal neglect. DCFS' responsibility under Federal and State law is to ensure there are POSCs for these vulnerable newborns.

All newborns exposed to or affected by substance abuse need a POSC. This also includes those cases that have been deemed invalid due to the mother having a verified prescription and taking it in a lawfully prescribed manner; however, the newborn had withdrawal symptoms. A POSC is required by Federal law and is designed to meet both the short-term and long-term needs of the family related to a substance-exposed newborn.

Services for the Infant
Citation: DSS Pol. Man. § 4-518(II)(D), (F)(1)

If the safety assessment determines that the newborn is safe and there are supports for the mother or treatment services available, the newborn may be able to be discharged to their mother's care with a POSC that includes necessary services and ongoing monitoring of the child's safety. Services such as home health, Homebuilders (where available), substance abuse treatment, Early Steps, and assistance from a spouse or partner or family member may provide sufficient safety for the newborn to remain with their family.

The newborn must be referred to an early intervention program to assure compliance with the Federal Child Abuse Prevention and Treatment Act requirement for referral for children under age 3 who are at risk for a developmental delay or are victims of abuse or neglect.

Services for the Parents or Other Caregivers
Citation: DSS Pol. Man. § 4-518(II)(F)(1)-(3)

A POSC includes numerous components, depending on the needs of the family, including the following:

• Risk and safety assessments
• Safety plans
• Substance abuse assessment or services
• Early Steps services for the newborn
• Medical services needed to meet the ongoing health needs of the newborn and their family
• Mental health services

A referral for substance abuse treatment services shall be initiated during the investigation when the mother is not already in a treatment program. An assessment of the mother is required. If the mother is not already in substance abuse treatment, this assessment is to occur through a formal substance abuse assessment conducted through the local governing authority or community provider credentialed to conduct a substance abuse assessment. To obtain an accurate assessment, it is critical to obtain a release-of-information form from the mother so background information can be shared with the assessor. The results of the assessment are a consideration in determining whether family services are needed or not. Random drug screens are also recommended as part of the assessment. It is recommended that all primary caregivers for the newborn undergo a formal substance abuse assessment.

Families should be referred for emergency services as needed when the POSC includes the newborn remaining in the home. Some of these services may include the following: 

• Homebuilders
• Family resource centers
• Maternal, Infant, and Early Childhood Home Visiting Services

Monitoring Plans of Safe Care
Citation: DSS Pol. Man. § 4-518(II)(F)(3)

The caseworker should discuss the following available information during the staffings involving substance-exposed newborns: 

• The infant's drug or alcohol exposure, as verified by toxicology and meconium reports of the infant; toxicology reports on the mother; or observable harmful effects, as verified by a physician
• Parental protective capacities (including any diminished protective capacities) of the mother and any other adult caregivers, both in and out of the home
• Review of safety assessments (current and impending danger) and safety plan, as applicable
• Information about any previous assessments and reports with valid findings, history of child abuse or neglect, mental illness, and substance abuse in applicable domains
• The status of substance abuse assessments of the mother and, when indicated, the father or other adult caregivers
• Prenatal care history and mother's substance use during this pregnancy and any indication of substance use during any previous pregnancies
• Postnatal information, including the infant's current condition and/or special needs or disabilities
• Recommendations for care and any referrals at discharge, such as home health
• Information on the parents' mental health concerns, such as postpartum depression and any co-occurring disorders
• Evidence of preparation and safe care for the infant, such as a crib, clothing, and formula
• The presence of other children in the home and their current care and condition
• Family system, strengths, involvement of infant's father and other family members, any history of agency involvement, and parental ability to use services to improve conditions
• Services or referrals, including Early Steps or Maternal, Infant and Early Childhood Home Visiting services, provided during the investigation
• Assessment of parental attachment (bonding and ability to parent the infant and any other siblings) of the mother, fathers of the infant, and other children in the home
• The names and contact information for the father and other relatives of the infant or children in the home