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

Definitions
Citation: Pol. Man. Letter # 03-2016(9-001)

In policy: The term 'exclusionary criteria' means criteria that, if alleged or otherwise learned by the Nebraska Department of Health and Human Services, automatically excludes a report accepted for assessment from eligibility for alternative response. Exclusionary criteria include the following:

• A newborn whose urine or meconium has tested positive for alcohol and whose caregiver (i) has an alcohol addiction, (ii) previously delivered a drug-exposed infant and did not successfully complete drug treatment, (iii) did not prepare for the newborn's birth, (iv) currently uses controlled substances or alcohol and breastfeeds or expresses intent to breastfeed, or (v) has no in-home support system or alternative primary care arrangements
• A pregnant woman who tested positive for methamphetamine or other controlled substance

Notification/Reporting Requirements
Citation: Rev. Stat. § 28-711; CARA Information factsheet

When any health-care provider has reasonable cause to believe that a child has been subjected to child abuse or neglect or observes such child being subjected to conditions or circumstances that reasonably would result in child abuse or neglect, they shall make a to the proper law enforcement agency or to the department.

From the factsheet: Providers must call the child abuse or neglect hotline anytime that child abuse or neglect is suspected through the mother's illicit use of opioids (those obtained from nonprescribed means) and they are unwilling to engage in treatment.

The provider must submit notification forms for the following:

• The mother is stable and engaged in opioid medicated-assisted treatment with a licensed physician.
• The mother is being treated with opioids for chronic pain by a licensed physician.
• The mother is stable and engaged in treatment for other nonopioid substance use, including alcohol, with a licensed provider.
• The infant is at risk for fetal alcohol spectrum disorder.

Assessment of the Infant and Family
Citation: Rev. Stat. § 28-712.01

A report involving an infant where a household member tests positive for methamphetamine or nonprescribed opioids at the birth of the infant shall not be assigned to alternative response but shall be immediately forwarded to law enforcement or the county attorney.

Responsibility for Development of the Plan of Safe Care
Citation: Pol. Man. Letter #53-2018(003.05(B)); CARA Information factsheet

If a report made by a hospital or other medical facility includes information that a newborn infant has been affected by substance use, withdrawal symptoms from prenatal drug exposure, or fetal alcohol spectrum disorder, the summary provided by the department may include any additional information the department deems necessary for the development of a plan of safe care (POSC) for the child.

From the factsheet: The Comprehensive Addiction and Recovery Act (CARA) of 2016 addresses maternal substance use disorders (SUD). It calls for a POSC to address the needs of both infants and their families or caregivers who are affected by substance exposure or maternal SUD. CARA was an amendment to the existing Child Abuse Prevention and Treatment Act requiring States to address the needs of substance-exposed infants, including the requirement to make appropriate referrals to child protective services and other appropriate services. The information in this document is intended to help Nebraska hospitals and providers meet the requirements of these laws.

A POSC is required to address the needs of both infants and their families or caregivers who are affected by maternal SUD. POSCs for mothers and infants are documented in maternal or neonatal medical records. This may be in the discharge summary or another section of the record. The development of the plan should involve the family, and a final copy should be given to them at discharge.

Services for the Infant
Citation: Admin. Code Tit. 92, § 52-006

School districts and approved cooperatives, as part of the child find system, must ensure that all infants and toddlers with disabilities within the district or approved cooperative who are eligible for early intervention services are identified, located, and evaluated, including infants and toddlers with disabilities who are identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure. A child under age 3 who is identified as directly affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure must be referred to the early intervention program.

Services for the Parents or Other Caregivers

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

Monitoring Plans of Safe Care
Citation: CARA Information factsheet

CARA also requires States to submit an annual report of related data to the Federal government.