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

Definitions
Citation: Admin. Code § 413-015-0115(32), (52); CW Proc. Man. Ch. 3, § 25

The term 'infant with prenatal substance exposure' means an infant, regardless of whether abuse is suspected, for whom prenatal substance exposure is indicated at birth. This includes any of the following circumstances:

• There is credible information that the birthing parent used substances during the pregnancy or at the time of birth.
• Prenatal substance exposure is determined by a positive toxicology screen from the infant or the birthing parent at delivery.
• An infant whose health care provider has identified signs of substance withdrawal; a fetal alcohol spectrum disorder diagnosis; or detectable physical, developmental, cognitive, or emotional delay or harm associated with prenatal substance exposure.

'Plan of care' means a written plan for an infant with prenatal substance exposure and the infant's family, focused on meeting health needs and substance use disorder treatment needs and developed in collaboration with the family, the health-care provider, community agencies, and the Department of Human Services when appropriate.

In policy:  'Substance-affected infant' means an infant, regardless of whether abuse is suspected, for whom prenatal substance exposure is indicated at birth and subsequent assessment by a health-care provider identifies signs of substance withdrawal; a fetal alcohol spectrum disorder (FASD) diagnosis; or detectable physical, developmental, cognitive, or emotional delay or harm that is associated with prenatal substance exposure.

Notification/Reporting Requirements
Citation: Ann. Stat. § 419B.010

Any public or private official who has reasonable cause to believe that any child with whom the official comes in contact has suffered abuse or that any person with whom the official comes in contact has abused a child shall immediately report or cause a report to be made.

Assessment of the Infant and Family
Citation: Admin. Code § 413-015-0212; CW Proc. Man. Ch. 3, § 25

When a screener receives a report that a child is identified as a substance-affected infant, the screener must do the following:

• Ask the reporter whether a plan of care has been developed
• Ask the reporter whether the substance-affected infant and family were referred to services

In policy: Prenatal substance exposure is determined by a positive toxicology screen from the infant or the mother at delivery or credible information that the mother had an active untreated substance use disorder during the pregnancy or at the time of birth.

In addition to the information typically gathered during the child protective services (CPS) assessment, the caseworker should ask questions specific to substance use when the report identifies an infant exposed to or affected by substances. 

• The nature and extent of the effects of substance exposure on the infant, if any
• The infant's medical condition and any current or ongoing health-care needs, including any of the following:
  • An extended hospital stay prior to discharge
  • Specific medical procedures, medication, specialized equipment
  • The need for more frequent monitoring
• Whether and when the infant's mother had prenatal care
• The name of the infant and the mother's health-care provider
• The nature and extent of the mother's current drug or alcohol use and that of the father and other caregivers, as follows:
• Current substance use (specific substance(s) used, frequency, intensity, duration, and amount of use)
• History of substance use (e.g., periods of abstinence)
• History of or refusal to enter substance use disorder treatment
• Results of prior substance use disorder treatment
• The nature and extent of any history of the following:
  • Mental illness
  • Intimate partner violence
  • Cognitive limitations
• Whether the mother is receiving medication-assisted treatment
• The nature and extent of the impact of the use on the mother's ability to provide proper care and attention to the infant
• The extent to which the parents are responsive to the infant's needs and are bonding with the infant (response to the infant's crying, eye contact, and other observations)
• Parents' protective capacity
• Parents' level of cooperation with any referrals for services, such as substance use disorder treatment, if indicated, or assistance in the care of the infant
• Parenting skills demonstrated in the health-care setting
• The anticipated discharge date and plan for discharge
• What family and social support system is available to the family
• Child welfare history
• The nature and extent of the alleged abusive behavior or circumstances (determine the presence and immediacy of concerning issues).

Responsibility for Development of the Plan of Safe Care
Citation: Admin. Code § 413-015-0415(13); CW Proc. Man. Ch. 3, § 25

When an infant is identified as an infant with prenatal substance exposure, the CPS worker must do the following:

• Ensure a plan of care is developed
• Ensure the infant with prenatal substance exposure and the infant's family are referred to the services identified in the plan of care
• Document the plan of care and the referrals made in the department's electronic information system

In policy: When a child is identified as a substance-affected infant, the caseworker must reach out to the health-care provider, hospital social worker, or others engaged with the family and determine if a plan of care has been developed and whether service referrals were made for the infant or the infant's family. The caseworker must ensure a plan of care is developed and that service referrals identified in the plan for the infant and the infant's family have been made. 

Developing a plan of safe care (POSC) involves input from the mother, father, and other caregivers and uses a multidisciplinary team approach to provide coordinated and complete care. The team may include the following:

• Child welfare workers
• Medical practitioners
• Substance-use disorder treatment staff
• Mental health practitioners
• Early childhood intervention specialists
• Home visitors
• Public health practitioners
• Members of the family's Tribe
• Others, as appropriate

While in most cases the health-care provider will be leading the plan of care's development, it is developed in collaboration with the family, other social service agencies, and—when child welfare is involved—with the CPS worker or permanency worker. If the health-care provider or other service providers are not taking the lead, it is important for the caseworker to do so. When a substance-affected infant is identified on an open CPS assessment, a plan of care must be developed and service referrals made.

If preferable, the caseworker can incorporate the elements of the plan into the ongoing safety plan or case plan, depending on which element fits best where and what plans are pertinent to the specific family. When a plan of care has been developed, or another person is taking the lead, the caseworker must ask for a copy or for information about the plan and referred services.

Services for the Infant
Citation: CW Proc. Man. Ch. 3, § 25

The POSC includes the physical health, substance use disorder treatment needs, general functioning, development, safety, and any special care needs of the infant who may be having physical effects or withdrawal symptoms from prenatal exposure.

Services for the Parents or Other Caregivers
Citation: Ann. Stat. § 430.915; CW Proc. Man. Ch. 3, § 25

If during routine pregnancy or prenatal care, the attending health-care provider determines that the patient uses or abuses drugs or alcohol or uses unlawful controlled substances, or the patient admits such use to the provider, it is the policy of this State that the provider encourage and facilitate counseling, drug therapy, and other assistance to the patient in order to avoid having the child, when born, become subject to protective services.

In policy: The POSC includes the following: 

• The parents' or caregivers' physical, social, and emotional health and substance use disorder treatment needs
• Services and supports to improve the parents' or caregivers' capacity to nurture and care for the infant

Monitoring Plans of Safe Care
Citation: CW Proc. Man. Ch. 3, § 25

The caseworker must identify the child as a substance-affected infant in OR-Kids. Identifying substance-affected infants will allow child welfare to track and report related data. It also is a way to identify children (and families) who may need additional support and services.