Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - North Dakota
Citation: Cent. Code § 50-25.1-02(4), (14), (15), (18)
'Alternative response assessment' means a child protection response involving substance-exposed newborns that is designed to do the following:
- Provide referral services to and monitor support services for a person responsible for the child's welfare and the substance exposed newborn
- Develop a plan of safe care (POSC) for the substance-exposed newborn
'Prenatal exposure to a controlled substance' means use of a controlled substance, as defined in chapter 19-03.1, by a pregnant woman for a nonmedical purpose during pregnancy, as evidenced by withdrawal symptoms in the child at birth, results of a toxicology test performed on the mother at delivery of the child at birth, or medical effects or developmental delays during the child's first year of life that medically indicate prenatal exposure to a controlled substance.
'Substance exposed newborn' means an infant younger than 28 days of age at the time of the initial report of child abuse or neglect and who is identified as being affected by substance abuse or withdrawal symptoms or by a fetal alcohol spectrum disorder (FASD).
Effective January 1, 2020: 'Neglected child' means a child who, due to the action or inaction of a person responsible for the child's welfare, was subject to prenatal exposure to chronic or severe use of alcohol or any controlled substance, as defined in chapter 19-03.1, in a manner not lawfully prescribed by a practitioner.
Citation: Cent. Code §§ 50-25.1-16; 50-25.1-17; 50-25.1-18
A mandatory reporter who has knowledge of or reasonable cause to suspect that a woman is pregnant and has used a controlled substance for a nonmedical purpose during the pregnancy shall report the circumstances to the Department of Human Services if the knowledge or suspicion is derived from information received by that individual in that individual's official or professional capacity. Any individual may make a voluntary report if the individual has knowledge of or reasonable cause to suspect that a woman is pregnant and has used a controlled substance for a nonmedical purpose during the pregnancy.
If the woman has obstetrical complications that are a medical indication of possible use of a controlled substance for a nonmedical purpose, a physician shall administer a toxicology test to a pregnant woman under the physician's care within 8 hours after delivery to determine whether there is evidence that she has ingested a controlled substance. If the test results are positive, the physician shall report the results under § 50-25.1-03.1. A negative test result or the pregnant woman's refusal to consent to a test does not eliminate the obligation to report if other evidence gives the physician reason to believe the patient has used a controlled substance for a nonmedical purpose.
If a physician has reason to believe based on a medical assessment of the mother or the infant that the mother used a controlled substance for a nonmedical purpose during the pregnancy, the physician shall administer, without the consent of the child's parents or guardian, to the newborn infant born under the physician's care a toxicology test to determine whether there is evidence of prenatal exposure to a controlled substance. If the test results are positive, the physician shall report the results as neglect. A negative test result does not eliminate the obligation to report if other medical evidence of prenatal exposure to a controlled substance is present.
A mandatory reporter who has knowledge of or reasonable cause to suspect that a woman is pregnant and has abused alcohol after the woman knows of the pregnancy may do either of the following:
- Arrange for an addiction assessment conducted by a licensed treatment program and confirm that the recommendations indicated by the assessment are followed
- Immediately report the circumstances to the department if the knowledge or suspicion is derived from information received by that individual in that individual's official or professional capacity
If the woman is referred for an addiction assessment and fails to obtain an assessment or refuses to comply with the recommendations of the assessment, a mandatory reporter who has knowledge of the failure to obtain the assessment or refusal to comply with recommendations of the assessment shall make a report to the department.
If a report alleges a pregnant woman has abused alcohol, the department shall immediately initiate an appropriate assessment and offer services indicated under the circumstances. Services offered may include a referral for addiction assessment, a referral for substance use disorder treatment, if recommended, or a referral for prenatal care. The department also may take any appropriate action under chapter 25-03.1.
Assessment of the Infant and Family
Citation: Cent. Code §§ 50-25.1-16; 50-25.1-18; CPS Pol. Man. § 640-37
If a report alleges a pregnant woman's use of a controlled substance for a nonmedical purpose, the department or its designee shall immediately initiate an appropriate assessment and offer services indicated under the circumstances. Services offered may include a referral for an addiction assessment, a referral for substance use disorder treatment if recommended, or a referral for prenatal care. The department or its designee may also take any appropriate action under chapter 25-03.1.
A report and assessment are not required if the pregnant woman voluntarily enters treatment in a licensed treatment program. If the pregnant woman does not complete voluntary treatment or fails to follow treatment recommendations, a mandatory reporter who has knowledge of the failure to complete voluntary treatment or failure to follow treatment recommendations shall make a report as required by this section. The report must be sufficient to identify the woman, the nature and extent of use, if known, the nature and extent of the abuse of alcohol, any health risk associated with the abuse of alcohol, and the name and address of the individual making the report.
In policy: Alternative response is the preferred response to reports of substance-exposed newborns and should be offered whenever the following are present:
- There has been a previous pregnant-woman assessment, and the mother engaged in service planning and development of a plan of safe care (POSC) for the infant.
- The initial report concerns an infant within the first 28 days of life.
- The concerns reported involve only prenatal exposure to abuse of alcohol or use of a controlled substance, and there are no other children involved where there are concerns of abuse or neglect.
- The initial report indicates that this is the first birth to this mother.
- There is no previous CPS history concerning the mother or other caregivers, or there is a history of previous CPS reports involving the mother or other caregivers that were administratively assessed, terminated in progress, or determined no services required.
- There was a previous services-required determination for neglect, and the parent followed through with required services, working successfully with the case manager.
- The newborn, or other siblings or household members, are not currently in the care and custody of a county or the department.
- The parent has no intellectual limitations that may impair the parent's ability to nurture or physically care for the child.
- The parent has no major psychiatric illness not currently controlled with medication.
- There is no current or recent (within 6 months) history of domestic violence in the home with the current partner.
Alternative response shall not be used when the following are true:
- The initial report contains abuse or neglect concerns for the newborn or other children in the home, in addition to substance exposure.
- The newborn affected by substance exposure is over 28 days old.
- There is a current open assessment involving abuse or neglect concerns, other than prenatal substance exposure.
- There is a history of previous CPS assessments with a services-required determination related to physical abuse, sexual abuse, or medical neglect or a recent assessment with a services-required determination (within 6 months).
- There is a history of failure to thrive, death of a child from abuse or neglect, or undetermined injury or death of an infant.
- The newborn, other siblings, or household members are currently in the care and custody of a county or the department.
- The parents or caregivers refuse.
Responsibility for Development of the Plan of Safe Care
Citation: Cent. Code § 50-25.1-21; CPS Pol. Man. § 640-37
In response to an alternative response assessment, the department shall do the following:
- Provide referral services to, and monitor support services for, the person responsible for the child's welfare, the substance-exposed newborn, and other children under the same care as may be necessary for their well-being
- Develop a POSC for the substance-exposed newborn
In policy: A POSC is an action plan to address the health and safety needs of the substance-exposed newborn and the health and substance use disorder treatment needs of the infant's caregivers. A POSC is intended to provide knowledge, services, and supports to sustain safety and health that begins during the CPS assessment and continues after the CPS intervention ends.
A POSC may be approached through the use of a family team, multidisciplinary team, family team decision-making, through individual contacts, or a combination of these. Use of a team approach that includes service providers and other informal supports is encouraged but not required. The primary purpose of a multidisciplinary approach to review reported cases of substance exposed newborns is to provide:
- Assistance in the determining appropriate and available community resources
- Advice and consultation regarding a case, based on individual members' expertise
- A forum that can be used to gauge community values and standards for the purpose of assessing risk of abuse or neglect
- Community advocacy on behalf of children and the children's families for the following purposes:
- To assist in assessing the needs, strengths, and problems of a child, family, other caregivers
- To assist in identifying services that can assist in the alleviation of identified needs
- To assist in determining which available resources within the community can be utilized
- To serve as a resource to community and professional organizations or groups
The fundamental value of the team process lies in the fact that information is evaluated by professionals of different perspectives. Collaboration is beneficial in enhancing the safety and well-being of children and families.
Services for the Infant
Citation: CPS Pol. Man. § 640-37
The POSC must include, but is not limited to, services and supports for the newborn, including the following:
- Any needed medical care
- Safe housing that protects the infant from environmental exposure to substances and persons under the influence of substances
- A general day-to-day plan for caring for the infant, including the caregiver's understanding of the special care needs of the infant and the ability to provide such care
- Referral to Part C Infant Development services
Services for the Parents or Other Caregivers
Citation: CPS Pol. Man. § 640-37
The POSC must include, but is not limited to, services and supports for the caregivers, including the following:
- Referral to necessary substance use disorder treatment services
- A list of phone numbers and contacts to call as a resource during a time of relapse and/or crisis or for general help with parenting issues
- Referral/follow up to any needed physical health services
- Inclusion of safe care for the infant in any relapse plan developed for the parent
- Provision of shaken baby syndrome prevention materials
- Provision of infant safe sleep information and ensuring safe sleep arrangements in the home
Other types of assistance that may be provided include parenting classes; safe drug-free housing; financial assistance; infant care needs, including clothing, supplies, formula, etc.; legal needs; transportation; and basic needs, including food and clothing, etc.
Monitoring Plans of Safe Care
Citation: Cent. Code § 50-25.1-20; CPS Pol. Man. § 640-37
If an alternative response assessment is initiated as a result of a report of child abuse or neglect, a decision that services are required may not be made if the person responsible for the child's welfare complies with the resulting referred services and POSC for the substance-exposed newborn. The department shall determine whether a person responsible for the child's welfare has complied with the referred services and POSC for the substance-exposed newborn. If the department determines a person responsible for the child's welfare has not complied with the referred services and POSC for the substance-exposed newborn, an assessment of the initial report of child abuse or neglect may be completed.
In policy: As required by the Child Abuse Prevention and Treatment Act (CAPTA), when a newborn has been identified as a substance-exposed newborn, CPS workers must monitor the POSC. The worker must ensure implementation of the POSC by following up with service providers and collateral contacts, including the family and other parties involved in the plan.
The POSC shall be monitored through a minimum of the following actions:
- Following hospital discharge, weekly contacts (with face-to-face contact every other week) must be made by CPS workers with the parents/caregivers and the infant.
- Any other children in the home must be assessed for safety throughout the assessment.
- The worker must make at least one face-to-face, or via electronic means, visit with each participant who agrees to act as a resource for emergency care of the infant in the POSC.
- The worker must contact (via email, text, etc.) each participant who is an informal support at least every other week.
- Contacts with service providers or follow-up contacts with safety support persons and other informal supports can be made by phone, email, in writing, text message, etc. to verify follow through with the plan.
- The worker must complete mandatory contacts with service providers before the case is closed.
All assessments with a POSC must include monitoring documentation. POSCs must be monitored for a minimum of 30 days prior to closing the assessment.