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

Definitions
Citation: Fam. Court Act § 1012(f)(i)(B); Pol. Memo. # 17-OCFS-LCM-03

The definition of 'neglected child' includes the failure of a parent or other caregiver to provide a minimum degree of care by misusing drugs or alcoholic beverages to the extent that the person loses self-control of their actions, provided, however, that where the respondent is voluntarily and regularly participating in a rehabilitative program, evidence that the respondent has repeatedly misused drugs or alcoholic beverages to the extent that they lose self-control of their actions shall not establish that the child is a neglected child in the absence of evidence establishing that the child's physical, mental, or emotional condition has been impaired or is in imminent danger of becoming impaired.

From the policy memo: To date, there is no Federal definition of a plan of safe care (POSC); however, for the purposes of this policy, a POSC must address the health and substance use disorder treatment needs of the infant and the affected family or caregiver. The POSC must address not only the immediate safety needs of the affected infant but also the health and substance use disorder needs of the affected family or caregiver. A POSC also should include referrals to appropriate services that support the affected infant and family or caregivers. The POSC should be developed with input from the parents and caregivers as well as from other professionals and agencies involved in serving the affected infant and family.

Notification/Reporting Requirements
Citation: CPS Pol. Man. Ch. 6, § J(2)

From the policy manual: Health-care providers are mandated reporters. If involved in the delivery or care of an infant who is affected by substance use disorder, exhibits withdrawal symptoms resulting from prenatal substance exposure, or is diagnosed with fetal alcohol spectrum disorder (FASD), the health-care provider must report to the Statewide Central Register of Child Abuse and Maltreatment (SCR) if there is reasonable cause to suspect that the infant has been abused or maltreated. Most reports citing positive toxicology of an infant are made in this manner.

Child protective services (CPS) will address the report with an investigation, or, where permitted, CPS may address it with a family assessment response.

The SCR should not register a report based on an infant's positive toxicology if the infant's birthing parent is compliant with a drug treatment program or is under the care and supervision of a doctor and is using the drugs as prescribed and is demonstrating an ability to care for the infant. Also, the SCR should not register a report if the only reported concern is that an infant tests positive for the presence of cannabis or alcohol without a demonstrated effect on the infant. If, however, the caller provides a reasonable cause to suspect that a child's physical, mental, or emotional condition has been harmed or is at risk of being harmed by a parent, the SCR will register a suspected child maltreatment report.

If a report is registered, a parent or person legally responsible should not be indicated simply for participating in a substance abuse treatment program. To indicate the parent of a child—including a newborn with a positive toxicology test—because of the parent's drug use or abuse, CPS must find that the child's physical, mental, or emotional condition has been impaired or is in imminent danger of becoming impaired. Evidence that a newborn infant tested positive for a drug or alcohol in its bloodstream or urine; or is born dependent on drugs, with drug withdrawal symptoms, or FASD; or has been diagnosed as having a condition that may be attributable to in utero exposure to drugs or alcohol is not sufficient, in and of itself, to support a determination that the child is abused or maltreated. In addition, such evidence alone is not sufficient for a local department of social services (LDSS) to take protective custody of such a child.

Assessment of the Infant and Family
Citation: CPS Pol. Man. Ch. 6, § J(2)

After receiving a report in which parental drug or alcohol misuse is alleged, CPS must determine whether there was such misuse and, if so, whether the child's physical, mental, or emotional condition was impaired or is at imminent risk. To determine whether the parent's drug or alcohol use creates a condition that places the child's physical, mental, or emotional condition in imminent danger of becoming impaired, CPS must assess the ability of the parent to care for the child, examining the parent's plans for the care of the child and their ability to follow through with those plans. In the case of a newborn infant born to a drug or alcohol-abusing parent, any special needs of that infant should be considered in CPS's assessment of parental capability.

Responsibility for Development of the Plan of Safe Care
Citation: Admin. Code Tit. 14., § 800.5(b), (c); CPS Pol. Man. Ch. 6, § J(2); Pol. Memo. # 17-OCFS-LCM-03

All certified substance abuse treatment programs shall have priority admission policies and procedures that establish immediate admission preference for pregnant persons or parent(s) or guardian(s) of children in or at risk of entering foster care.

All substance abuse treatment programs shall offer development of a plan of safe care to any pregnant patients in accordance with guidance issued by the Office of Addiction Services and Supports.

In policy: The abuse of drugs or alcohol by parents of children, including newborn infants who present with a positive toxicology after birth, is one of the more difficult situations confronting CPS. The benefits of maintaining the parent-child bond must be weighed against the parent's ability to provide adequate care for the infant.

Whenever an infant is identified as being exposed to substances, the State must provide for the development of a POSC that addresses the health and substance use disorder treatment needs of both the infant and the affected family or caregiver. The POSC must address not only the immediate safety needs of the affected infant but also the health and substance use disorder needs of the affected family or caregiver. A POSC should include referrals to appropriate services that support the affected infant and family or caregivers.

The POSC should be developed with input from parents and caregivers as well as from professionals and agencies involved in serving the affected infant and family. It may be written by a physician, other medical provider, CPS, social worker, or another entity.

Whenever a report of suspected abuse or maltreatment involves an infant exposed to substances, CPS must document the POSC in its case records. In some instances, a POSC may have been developed by medical professionals or substance abuse treatment providers prior to the involvement of CPS. The case file should clearly document the POSC, whether developed by CPS or other professionals involved.

From the policy memo: Consistent with good casework practice, CPS workers must develop a POSC with input from the parents and caregivers as well as from other professionals and agencies involved in caring for the infant and family. When possible, communication about a POSC should begin prior to an infant's discharge from the hospital.

The case progress notes must include the details of the POSC and identify any other professionals who were involved in the development of the plan and what appropriate service referrals were made by either CPS or the other professionals involved with the family.

Services for the Infant
Citation: CPS Pol. Man. Ch. 6, § J(2)

CPS must offer or make referrals for appropriate services in cases in which an infant has a positive toxicology screening for drugs. Such services can be especially important in preventing the separation of mother and child. Referrals and services may include, but are not limited to, home visiting, early intervention screening, and services. Depending on the determination of the report, the services offered could be either mandated or optional preventive services, offered directly by the LDSS or through a purchase-of-service agreement designed to prevent out-of-home placements.

Services for the Parents or Other Caregivers
Citation: Admin. Code Tit. 14., § 822.8(k); CPS Pol. Man. Ch. 6, § J(2); Pol. Memo. # 17-OCFS-LCM-03

Treatment plans must include provisions for prenatal care for all patients who are pregnant or become pregnant. If a pregnant patient refuses or fails to obtain such care, the provider must have the patient acknowledge in writing that prenatal care was offered and refused. The program should also offer to develop a POSC with the patient and anyone identified by the patient.

In policy: CPS must offer or make referrals for appropriate services in cases in which an infant has a positive toxicology screening for drugs. Such services can be especially important in preventing the separation of mother and child. Referrals and services may include, but are not limited to, substance use disorder treatment services (both outpatient and inpatient), home visiting, and early intervention screening, and services. Depending on the determination of the report, the services offered could be either mandated or optional preventive services, offered directly by the LDSS or through a purchase-of-service agreement designed to prevent out-of-home placements.

From the policy memo: Preventive services include supportive and rehabilitative services that are provided to children and families in accordance with New York State regulations and Social Services Law. Mandated and optional preventive services offered directly by the LDSS or through a purchase-of-service agreement are designed to prevent out-of-home placements. Supportive and rehabilitative services for children and adults include, but are not limited to, the following:

• Case management
• Case planning
• Child daycare services
• Homemaker services
• Housekeeper or chore services
• Family planning services
• Home management services
• Clinical services
• Parent-aid services
• Day services to children
• Parent training
• Transportation services
• Emergency cash or goods
• Emergency shelter
• Preventive housing services
• Intensive, home-based, family preservation services
• Outreach activities
• Respite care

Monitoring Plans of Safe Care
Citation: Pol. Memo. # 17-OCFS-LCM-03

The Offices of Child and Family Services (OCFS) will continue to access information on infants with the following designated safety factors:

• The child has a positive toxicology for legal or illegal drugs or alcohol.
• The caregiver(s) currently abuses alcohol, to the extent that it seriously affects their ability to supervise, protect, or care for the child(ren).
• The caregiver(s) currently abuses legal or illegal drugs, to the extent that it seriously affects their ability to supervise, protect, or care for the child(ren).

OCFS will also monitor case documentation on the development and implementation of the POSCs through the review of child protective services cases using the ongoing monitoring assessment process.