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, that results in symptoms of withdrawal in the newborn; or the presence of a controlled substance or a metabolic thereof in his or her body, blood, urine, or meconium that is not the result of medical treatment; or observable and harmful effects in his or her 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 his or her 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 his or her 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 of 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)

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

• The mother's acknowledgement or lack of acknowledgement of substance abuse issues
• The mother's prior agency and substance abuse history
• The mother's behavior and interaction/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 addresses the needs of the substance-exposed newborn and the family, an assessment must be made to determine if a referral to family services or foster care is needed. When the case is transferred, the caseworker should discuss the following available information during the staffings involving the newborn:

• The infant's drug or alcohol exposure, as verified by toxicology reports, or observable harmful effects, as verified by a physician
• Parental protective capacities of the mother and any other adult caregivers both in and out of the home
• Review of safety assessments and the safety plan, as applicable
• Any previous assessments and reports with valid findings, history of child abuse or neglect, mental illness, and substance abuse
• The status of substance abuse assessment of the mother and, when indicated, the father or other adult caregiver
• Prenatal care history and mother's substance use during this pregnancy and any previous pregnancies
• Postnatal information, including the infant's current condition and/or special needs or disabilities
• Information on the parent's mental health concerns, such as postpartum depression and any co-occurring disorder
• 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 strengths, involvement of the infant's father and other family members, any history of agency involvement, and parental ability to use services to improve conditions
• Services and/or referrals provided during the investigation
• Assessment of parental attachment (bonding and ability to parent the infant and any other siblings) of the mother, father of the infant, and other children in the home
• Name and contact information for the father and other relatives of the infant/children in the home

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 assure there are plans for the safe care (POSC) for these vulnerable newborns.

All newborns exposed/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 is safe and there are supports for the mother and/or treatment services available, the newborn may be able to be discharged to his mother's care with a POSC that includes necessary services and on-going monitoring of the child's safety. Services such as home health, Homebuilders (where available), substance abuse treatment, Early Steps, and assistance from a spouse/partner or family member may provide sufficient safety for the newborn to remain with his or her 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 and/or is a victim of abuse/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/services
• Early Steps services for the newborn
• Medical services needed to meet the ongoing health needs of the newborn and his or her 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 also are 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 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/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 and/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/children in the home