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

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

In policy: A 'controlled substance' is a drug, substance, or immediate precursor. Controlled substances include illicitly used drugs or prescription medications. 

Notification/Reporting Requirements 
Citation: Comp. Laws § 722.623a; Prot. Serv. Man. PSM 716-7

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 their 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 their mother.

In policy: A referral involving only substance use is insufficient for investigation or confirmation of child abuse or child neglect. Parents and caregivers may use legally or illegally obtained substances and prescribed medications to varying degrees and remain able to safely care for their children.

Substance use by a parent or caregiver may be a risk factor for child maltreatment. For cases involving known substance use, case managers must evaluate its impact on child safety. Substance abuse is a mental health disorder. Case managers should assist the parent or caregiver in accessing relevant supports and services.

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
• A medical professional report of the child having symptoms that indicate exposure 

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

• Contact with medical staff to obtain confirmation of the following information, if available:
  • Results of medical tests indicating infant exposure to substances or alcohol
  • The health and status of the infant
  • Documented symptoms of withdrawal experienced by the infant
  • Medical treatment the child or mother may need
• Observations of the parent's care of the infant(s) and the parent's response to the infant's needs
• Interview with the infant'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 infant and other children in the home 

To be considered serious physical abuse, a medical practitioner must confirm the infant's exposure and any related symptoms meet the definition of serious physical harm.

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.

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 a 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 birthing parent or caregiver
• The needs of all household members, including caregivers who reside outside of the home 

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: 

• Early On
• Home visitation program 

Monitoring Plans of Safe Care
Citation: Prot. Serv. Man. PSM 716-7

The referral and implementation of these services must be documented by the case manager in the department information system.

There may be situations in which case managers determine that substance or alcohol screens for parents or other persons responsible for the child's care are necessary. Screening frequency should not exceed twice monthly unless there is a need to verify use or abstinence or a court order requiring additional screening. Substance use screening should not be completed as a punitive action. Regardless of the outcome of the drug screen, case managers should continuously engage with the parent, provide the parent with applicable services, and assess the impact of the parent's substance use.