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

Date: August 2019


Citation: Prot. Serv. Man. PSM 716-7

A 'controlled substance' is a drug or chemical that is regulated by the government. Controlled substances include illicitly used drugs or prescription medications.

The term 'passive exposure' refers to exposure to a substance that occurs through being in the presence of someone smoking, inhaling the substance, or coming in physical contact with the substance, but not actively using the substance themselves. Prenatal exposure is an example of passive exposure.

Notification/Reporting Requirements

Citation: Comp. Laws § 722.623a

A person who is required to report suspected child abuse or neglect and who knows, or from the child's symptoms has reasonable cause to suspect, that a newborn infant has any amount of alcohol, a controlled substance, or a metabolite of a controlled substance in his or her body shall report to the Department of Health and Human Services. A report is not required if the person knows that the alcohol, controlled substance, or metabolite, or the child's symptoms, are the result of medical treatment administered to the newborn infant or his or her mother.

Assessment of the Infant and Family

Citation: Prot. Serv. Man. PSM 716-7

Child Protective Services (CPS) will investigate complaints alleging that an infant was born exposed to substances not attributed to medical treatment when exposure is indicated by any of the following:

  • A positive urine screen of the newborn
  • A positive result from meconium or umbilical cord tissue testing
  • Confirmation by a medical professional of withdrawal symptoms in a newborn that are not the result of medical treatment

Along with standard investigation activities that apply in all other cases, investigations involving substance- or alcohol-exposed infants also must include the following:

  • Contact with medical staff to obtain confirmation of the following information:
    • Results of medical tests indicating that the newborn was exposed to substances and/or alcohol
    • The health and status of the newborn
    • Documented symptoms of withdrawal experienced by the newborn
    • Medical treatment the child or mother may need
  • Observations of the parents care of the newborn and the parent's response to the newborn's needs
  • Interview with the newborn's parents and any relevant caregivers to assess the need for a referral for substance use prevention, treatment, or recovery services
  • Assessment of the parent's capacity to adequately care for the newborn and other children in the home

Parental substance use or positive toxicology in a newborn does not in and of itself prove child abuse or neglect. A caseworker will need to determine if harm has occurred or is likely to occur, not simply if the child has been affected by or exposed to a substance.

Parental substance use is a risk factor, not a determinant for case confirmation. Many children of parents who are dependent on substances will not experience abuse or neglect or suffer negative developmental outcomes. They may, however, be at an increased risk for maltreatment and entering the child welfare system.

For guidance in assessing parent capacity and decision making, caseworkers should consider the following:

  • Does the use extend to the point of intoxication, unconsciousness, or inability to make appropriate decisions for the safety of their child(ren)?
  • Does the use of substances cause reduced capacity to respond to the child's cues and needs?
  • Is there evidence to demonstrate difficulty regulating emotions or controlling anger?
  • Are negative emotions, such as aggressiveness or impulsivity, regularly demonstrated?
  • Is there an appearance of being sedated or inattentive?
  • Is there demonstrated ability to consistently nurture and supervise the child(ren) according to their developmental needs?
  • Do co-occurring issues exist that would impact parenting or exacerbate risk, such as the following:
    • Social isolation
    • Poverty
    • Unstable housing
    • Domestic violence
  • Are there supports, such as family and friends, who can care for the child(ren) when the parents are not able to? Are the parents willing to use their supports when necessary?
  • Has the use of substances caused substantial impairment of judgment or irrationality to the extent that the child was abused or neglected?
  • Are there any other factors that demonstrate an inability to protect the child(ren) and maintain child safety?

Responsibility for Development of the Plan of Safe Care

Citation: Prot. Serv. Man. PSM 716-7

In an investigation involving an infant born exposed to substances or having withdrawal symptoms, or fetal alcohol spectrum disorder, the caseworker must develop a safe care plan that addresses the following:

  • The health and safety needs of the infant
  • The substance use treatment needs of the mother
  • The needs of other household members

Services for the Infant

Citation: Prot. Serv. Man. PSM 716-7

Regardless of case disposition, services must be provided to the infant and family by the department or another service provider, including, but not limited to, one of the following services:

  • Early On
  • Home visitation program

Services for the Parents or Other Caregivers

Citation: Prot. Serv. Man. PSM 716-7

Regardless of case disposition, services must be provided to the infant and family by the department or another service provider, including, but not limited to, one of the following services:

  • Home visitation program
  • Substance use disorder prevention, treatment, or recovery
  • Family preservation

Monitoring Plans of Safe Care

Citation: Prot. Serv. Man. PSM 716-7

The referral and implementation of these services must be documented by the caseworker in both the social work contacts and the case disposition narrative in MiSACWIS.