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

Date: August 2019


Citation: Pol. Man. Letter # 03-2016; Safety Assess. Man.

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

The term 'drug-exposed infant' is used when there is evidence that the mother used alcohol or other drugs during pregnancy and this has created imminent danger to the infant, including the following:

  • Indicators of drug use during pregnancy, including drugs found in the mother's or child's system, the mother's self-report, a diagnosed high-risk pregnancy due to drug use, efforts on mother's part to avoid toxicology testing, withdrawal symptoms in mother or child, or preterm labor due to drug use
  • Indicators of imminent danger, including the level of toxicity and/or type of drug present; the infant being diagnosed as medically fragile as a result of drug exposure; or the infant suffering adverse effects from the introduction of drugs during pregnancy

Notification/Reporting Requirements

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

Assessment of the Infant and Family

Citation: DCFS Proc. Man. #5-2019

A drug-exposed infant allegation requires that an infant has a positive urine or meconium test for alcohol or drugs. The birth parent's toxicology screen is only relevant if there is a positive test for methamphetamine and/or heroin.

If the child tests positive for any substance other than methamphetamine or heroin, the Division of Children and Family Services (CFS) specialist must consider the parent's situation and observations of bonding and interaction with the infant. The CFS specialist must accept the report if there is reason to believe that the parent will be unable to meet the child's basic needs (or arrange for those needs to be met) after leaving the hospital. Examples include, but are not limited to, the following:

  • The parent has an addiction€”defined as a persistent pattern of use over time that interferes with functioning (e.g., family, holding down job, involvement with law enforcement).
  • There is a documented history of use, including a prior delivery of a drug-exposed newborn, without evidence of subsequent successful treatment.
  • There is no evidence of preparation for the child's arrival (e.g., prenatal care; preparation of a sleeping area; purchasing diapers, formula, stroller, etc.).
  • There is evidence of current use and stated intent to breast-feed or observation of current breast-feeding by hospital staff/reporters.
  • There is no evidence of an in-home support system (e.g., another adult in the household who is able to provide care and protection for the child).

Indicators that the parent will be able to meet the child's needs include the following:

  • Evidence that the parent has made appropriate arrangements for alternate care of her child (e.g., for another family member to assume primary care responsibilities for the child).
  • The drug identified is one that remains in the system for a significant period after use and there are no indications that the parent is currently using (e.g., has completed treatment since becoming pregnant).

Responsibility for Development of the Plan of Safe Care

Citation: Pol. Man. Letter #53-2018

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 for the child.

Services for the Infant

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

Services for the Parents or Other Caregivers

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

Monitoring Plans of Safe Care

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