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

Definitions

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

Notification/Reporting Requirements
Citation: Ann. Stat. § 191.737

Notwithstanding the physician-patient privilege, any physician or health-care provider may refer to the Children's Division families in which children may have been exposed to a controlled substance or alcohol, as evidenced by a written assessment made or approved by a physician, health-care provider, or by the division that documents the child as being at risk of abuse or neglect and either of the following apply:

• Medical documentation of signs and symptoms consistent with controlled substances or alcohol exposure in the child at birth
• Results of a confirmed toxicology test for controlled substances performed at birth on the mother or the child

Notwithstanding the physician-patient privilege, any physician or health-care provider shall refer to the division families in which infants are born and identified as affected by substance abuse, withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder (FASD), as evidenced by either of the following:

• Medical documentation of signs and symptoms consistent with controlled substances or alcohol exposure in the child at birth
• Results of a confirmed toxicology test for controlled substances performed at birth on the mother or the child

Nothing in this section shall preclude a physician or other mandated reporter from reporting abuse or neglect of a child as required pursuant to the provisions of § 210.115.

Assessment of the Infant and Family
Citation: CW Man. § 3, ch. 1; 2

In policy: Newborn crisis assessment cases: In these cases, a home assessment is requested by a physician or health-care provider about a newborn child. These are emergency requests from hospitals for drug- and nondrug-related situations and involve an infant when personnel have serious concerns about the risk to the child upon release from the hospital. Nondrug-involved referrals will be accepted until the child is 1 year of age.

The family-centered services (FCS) assessment is defined as an ongoing process that evaluates and identifies the current level of family functioning, the current risk to the child(ren), and the family strengths and service needs. Various assessment tools are used to assist staff in conducting thorough and comprehensive assessments of the following:

• Family history
• Child safety
• Family structure and functioning
• Family strengths and supports
• The family's level of risk for future child maltreatment
• The family's need for services

Responsibility for Development of the Plan of Safe Care
Citation: Ann. Stat. § 191.739

The Department of Social Services shall provide protective services for children that meet the criteria established in § 191.737. In addition, the department may provide preventive services for children that meet the criteria established in § 191.737.

No department shall cease providing services for any child exposed to substances when a physician or health-care provider has made or approved a written assessment that documents the child as being at risk of abuse or neglect until a physician or health-care provider authorizes such file to be closed.

Services for the Infant
Citation: Code of Regs. Tit. 9, § 30-3.190; CW Man. § 3, Ch. 3

The Comprehensive Substance Treatment and Rehabilitation (CSTAR) Program for Women and Children shall provide treatment services and other supports solely to women and their children. Program staff shall inform women of the services available for children and educate them about involving their children in treatment while respecting the mother's wishes.

When the mother chooses to involve her children in treatment, a trained staff member shall complete an initial screening utilizing an age-appropriate, validated instrument to determine specific service needs beyond child care and community support. The screening shall include an interview with at least one parent and the child, whenever appropriate.  

An individual plan shall be developed based on the needs of the mother and child, with the results of the assessment serving as a guide. The child's consent for treatment must be signed by the legal guardian. Developmentally appropriate activities and services shall be offered to meet the social, emotional, and behavioral needs of children to accomplish the following: 

• Build self-esteem and self-awareness
• Learn to identify and express feelings
• Build positive family relationships
• Learn healthy social engagement, peer relationships, social pressure skills, and teamwork
• Develop decision-making skills
• Learn self-management (impulse control, stress management, and goal-setting)
• Understand substance use disorders and their effects on the family
• Learn and practice nonviolent ways to resolve conflict
• Learn safety practices such as personal space, boundaries, and personal safety
• Address developmental needs
• Provide education on preventing alcohol, tobacco, and other drug use   

Services for children shall address the issues and needs identified by the mother and her children, as documented in the individual plan, utilizing structured and unstructured therapeutic activities. Specialized services shall be provided, including, but not limited to, children with high risk of sexual abuse, sexual acting-out behaviors, suicide risk, and the service needs of infants, toddlers, and preschoolers.  

Services for children from birth to age 3 shall include, at a minimum, developmentally appropriate parent-child interactive bonding activities and developmentally appropriate structured activities that promote and nurture the growth and well-being of the infant.  

In policy: Children should be connected to services that address any identified needs they may have for any of the following:

• Medical and dental care
• Mental health care
• Substance use treatment
• Educational services
• Services to increase well-being
• Specialized services and supports for children with special needs

Services for the Parents or Other Caregivers
Citation: Ann. Stat. § 191.731; Code of Regs. Tit. 9, § 30-3.190; CW Man. § 3, Ch. 3

A pregnant woman referred for substance abuse treatment shall be a first-priority user of available treatment. All records and reports regarding such pregnant woman shall be kept confidential. The Division of Alcohol and Drug Abuse shall ensure that family-oriented substance abuse treatment be available, as appropriations allow. Substance abuse treatment facilities which receive public funds shall not refuse to treat women solely because they are pregnant.

CSTAR services shall be based on individual and family needs, in accordance with admission and eligibility criteria for CSTAR. Priority admission shall be for women who meet the following criteria: 

• They are pregnant and inject drugs
• They are pregnant or postpartum (up to 1 year after delivery)
• They have children in their care and custody, including those at risk of losing custody or attempting to regain custody of their children
• They are applicants or recipients of Temporary Assistance for Needy Families referred by the Department of Social Services, Family Support Division
• They can be included in other populations specified by the department.   

In regulation: Women who meet priority criteria shall be immediately admitted to the CSTAR program and receive appropriate services. If the program is unable to provide immediate admission, staff shall facilitate referral to another women and children's CSTAR program that can provide immediate admission. If immediate admission with an alternative women and children's CSTAR program is not available for a woman who is pregnant, program staff shall contact designated department staff to obtain assistance in facilitating arrangements for immediate admission with another program. Women shall not be denied admission based solely on medication prescribed and monitored by a licensed physician, physician assistant, or advanced practice registered nurse for an opioid disorder or other physical or behavioral health disorder.  

Services shall be designed to assist women in maintaining their recovery and resiliency, including the following: 

• Parenting and child development
• Life skills
• Family programs
• Facilitation of supervised parent-child bonding
• Educational remediation and support
• Employment readiness services
• Linkages with legal and child welfare systems, including reunification with children if applicable
• Housing support efforts and referrals
• Co-occurring disorder services, including access to psychological and pharmacological treatments for mental health disorders
• Education and linkage to eating disorder and nutrition services
• Medication services, including access to approved medication to treat substance use disorders for women who are pregnant
• Recovery support and community support services that address long-term recovery needs such as domestic violence services, career counseling, legal services, and transportation services

Family oriented living arrangements, indoor recreational space for children and families, and safe, protected outdoor recreational and leisure space shall be available. Women and their children shall have access to age-appropriate physical health care, including obstetric and pediatric care.  

Services shall be designed to assist women in maintaining their recovery and resiliency, including the following: 

• Parenting and child development
• Life skills
• Family programs
• Facilitation of supervised parent-child bonding
• Educational remediation and support
• Employment readiness services
• Linkages with legal and child welfare systems, including reunification with children if applicable
• Housing support efforts and referrals
• Co-occurring disorder services, including access to psychological and pharmacological treatments for mental health disorders
• Education and linkage to eating disorder and nutrition services
• Medication services, including access to approved medication to treat substance use disorders for women who are pregnant
• Recovery support and community support services that address long-term recovery needs such as domestic violence services, career counseling, legal services, and transportation services

The program shall ensure child care is not a barrier to engagement in services or retention in treatment by ensuring coordination or facilitation of child care when the mother is participating in services.

In policy: Families may be referred to any available culturally relevant community resources that help them meet basic needs, including any of the following:

• Housing referral and assistance
• Public benefits and income support, including assistance in obtaining food, clothing, and utility services
• Child care
• Medical and dental care
• Respite care
• Transportation services
• Vocational and educational assistance

Families that come to the attention of the Children's Division through a newborn crisis assessment may be referred to the home visiting (HV) program. HV is an in-home service designed to assist with the prevention of child abuse and neglect by offering additional in-home support to income-eligible parents who are currently pregnant or have a child under age 3. The program provides parents with various opportunities to gain skills in the areas of child abuse and neglect prevention, early childhood development and education, parenting skill development, and school readiness. Each program is developed to include incentives for families. Some of these incentives include, but are not limited to, diapers and wipes, formula, educational toys and books, clothes, gas cards, or cribs and car seats.

Monitoring Plans of Safe Care
Citation: CW Man. § 3, Ch. 3

At a minimum, the caseworker must complete one face-to-face home visit with the family per month on all FCS cases. The caseworker must meet with all family members to adequately assess risk and safety, with it being especially important to see all the children.