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

Definitions

Citation: Ann. Stat. Tit. 10A, § 1-1-105; DHS Pol. Man. § 340:75-3-120

'Deprived child' means a child who is a child in need of special care and treatment because of the child's physical or mental condition, and the child's parents, legal guardian, or other custodian is unable or willfully fails to provide such special care and treatment. As used in this paragraph, a child in need of special care and treatment includes, but is not limited to, a child who at birth tests positive for alcohol or a controlled dangerous substance and who, pursuant to a drug or alcohol screen of the child and an assessment of the parent, is determined to be at risk of harm or threatened harm to the health or safety of a child.

'Plan of safe care' (POSC) means a plan developed for an infant with neonatal abstinence syndrome or a fetal alcohol spectrum disorder upon release from the care of a health-care provider that addresses the health and substance use treatment needs of the infant and mother or caregiver.

In policy: 'Fetal alcohol spectrum disorder' (FASD) is an overarching phrase that encompasses a range of possible diagnoses, including fetal alcohol syndrome (FAS), partial fetal alcohol syndrome, alcohol-related birth defects (ARBDs), alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure.

'Neonatal abstinence syndrome' (NAS), also referred to as 'substance-affected newborn' or commonly known as withdrawal, is caused by in utero exposure to legal or illegal drugs or substances.

A 'substance-affected infant' is an infant who was born experiencing withdrawal symptoms as a result of prenatal drug exposure or an FASD, as determined by the direct health-care provider.

A 'substance-exposed infant' is a newborn who tests positive for alcohol or a controlled dangerous substance. When the mother's substance use or abuse results in an infant born substance-exposed, the mother's home is evaluated to determine if the infant can receive the proper nurturing, nutrition, and attention to hygiene necessary for the infant to thrive.

Notification/Reporting Requirements

Citation: Ann. Stat. Tit. 10A, § 1-2-101; DHS Pol. Man. § 340:75-3-130

Every physician, surgeon, or other health-care professional, including doctors of medicine, licensed osteopathic physicians, residents, and interns, or any other health-care professional or midwife involved in the prenatal care of expectant mothers or the delivery or care of infants shall promptly report to the Department of Human Services instances in which an infant tests positive for alcohol or a controlled dangerous substance. This shall include infants who are diagnosed with NAS or FASD.

In policy: When a report is received concerning an infant diagnosed with NAS or FASD, the report is not accepted for investigation, and the following steps will be completed:

• The information is documented and screened out by the Hotline supervisor with a screen-out reason of 'plan of safe care.'
• The POSC referral is entered and assigned to the mother's county of residence.

A new report is entered and forwarded to the Hotline any time the NAS- or FASD-diagnosed infant is at risk of abuse or neglect.

Assessment of the Infant and Family

Citation: DHS Pol. Man. § 340:75-3-450

When an infant is alleged to be born substance-exposed or affected, the child welfare (CW) specialist will obtain the infant's test results. Cord blood is the preferred testing method. When cord blood is not available, meconium is the preferred testing method.

The CW specialist evaluates the impact of the following:

• Substance use or abuse on the person responsible for the child's (PRFC's) health, safety, and welfare ability to provide care for the infant
• The PRFC's drug of choice and how it affects the PRFC's overall functioning, cognitive ability, and safety decisions

The PRFC who uses methamphetamines, phencyclidine (PCP), heroin, or cocaine, or any combination of drugs is viewed as unable to provide minimal basic care for the infant or child.

Responsibility for Development of the Plan of Safe Care

Citation: Ann. Stat. Tit. 10A, § 1-2-102; DHS Pol. Man. § 340:75-3-450

Whenever the department determines an infant has been diagnosed with NAS or FASD, but the referral is not accepted for investigation, the department shall develop a POSC that addresses both the infant and affected family member or caregiver. The POSC shall address, at a minimum, the health and substance use treatment needs of the infant and affected family member or caregiver.

Whenever the infant is diagnosed with NAS or FASD, the CW specialist develops a POSC for the infant and mother or caregiver, as follows:

• When a referral is received and subsequently screened out and assigned as a POSC, contact is made with the mother or caregiver within 5-business days of receiving the referral.
• When a referral is received and accepted for Child Protective Services (CPS) investigation, a POSC is required in addition to following CPS investigation and safety analysis protocols.
• The CW specialist inquiries about any plans previously developed by a hospital or medical professional to address the infant's and the mother's or caregiver's health and substance use or abuse treatment needs. Such plans are appropriate for inclusion in the POSC.

Services for the Infant

Citation: DHS Pol. Man. § 340:75-3-450

An infant who tests positive is referred to services to alleviate the effects of the substance on the child's development.

The POSC includes referring the infant to SoonerStart (early intervention program) and a medical provider to evaluate the effects of the substance on the child's development. When available, a referral to a pediatric NAS clinic is preferable.

Services for the Parents or Other Caregivers

Citation: DHS Pol. Man. § 340:75-3-450

The mother or caregiver is referred to substance use or abuse services that include a substance abuse assessment.

As part of the POSC, the CW specialist evaluates if other service referrals are needed for the parent or caregiver and makes those referrals as necessary. Examples may include referrals to receive assistance with housing, transportation, or daycare services.

Monitoring Plans of Safe Care

Citation: Ann. Stat. Tit. 63, § 1-550.3; DHS Pol. Man. § 340:75-3-450

The department shall establish and maintain an up-to-date record of infants born exposed to alcohol and other harmful substances. The record shall include data necessary for surveys and scientific research and other data that is necessary and proper to further the recognition, prevention, and treatment of infants born addicted to or prenatally exposed to harmful substances. The record shall include, but not be limited to, the following information:

• The classification of the birth hospital, whether it is public or private
• Results of the toxicology report on an infant and its mother and, if positive, the type of drug or drugs involved
• The date of birth, birth weight, gestational age, and race of the infant
• The county of residence
• The date and county of the report
• Demographic information on the mother, including, but not limited to, age, race, education level, marital status, and income level; whether prenatal care was received and the type of prenatal care received; and whether the care was received was private or in a public health clinic or hospital clinic
• The type of treatment and whether the mother was referred for inpatient or outpatient care
• Whether the child was recommended for removal from the custody of the parent

The department of shall compile and evaluate information received from the reports required pursuant to this section into a report to be distributed on or before January 1 of each year to the governor, the president pro tempore of the senate, the speaker of the house of representatives, and such other persons as the department deems advisable or necessary.

In policy: Within 60 calendar days of the POSC's assignment, the CW specialist shall contact the service providers and parent or caregiver prior to the POSC's closure to find out the infant's and the mother's or caregiver's progress in services. At any time during the POSC referral when the CW specialist becomes aware of allegations of abuse or neglect or has concerns for the safety of the newborn or children in the home, the CW specialist will inform the mother or caregiver that the POSC referral is being upgraded to a CPS investigation. The CW specialist will then begin a CPS investigation and safety analysis, per regulation.