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

Definitions

Citation: Admin. Code § 413-080-0050

'Plan of care' means a written plan for a substance-affected infant and the infant's family, focused on meeting health needs and substance disorder treatment needs and developed in collaboration with the family, the health-care provider, community agencies, and the child welfare agency, when appropriate.

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

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. 4, § 20

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 addressed in ongoing safety plans and case plans, the caseworker should address behaviors, conditions, and circumstances specific to substance use when an infant on their caseload has been exposed to or affected by substances.

When working with a substance-exposed or substance-affected infant and the infant's family, the caseworker, in addition to the typical planning considerations, should consider planning specific to substance use and infant care, such as the following:

• Treatment compliance (e.g., attendance to individual, group, case management meetings; drug-testing attendance and results)
• Treatment progress (e.g., treatment plan progress, behavioral changes, phase progression)
• Changes in treatment plan (e.g., diagnosis, level of care, drug-testing requirements, service recommendations)
• Observations of parent-child interaction, including any child risk and safety concerns (e.g., unsafe home environment or parent relocation, indicators of substance use)
• Outcomes monitoring (e.g., sustaining long-term recovery, improved functioning)

Responsibility for Development of the Plan of Safe Care

Citation: Admin. Code § 413-080-0065; CW Proc. Man. Ch. 4, § 20

When a child on an open case is identified as a substance-affected infant, the caseworker must do the following:

• Ensure a plan of care is developed
• Ensure the substance-affected infant and family are referred to services identified in the plan of care
• Document the plan of care and referrals made in the Department of Human Services' electronic information system

In policy: When providing support and services to families where substance use is identified, it is important to use a multidisciplinary approach that draws on trauma-informed professional expertise across agencies. These providers include medical providers; public health, such as home visiting nurses; chemical dependency programs; social services; mental health; and early intervention services.

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 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 permanency worker to do so. When a substance-affected infant is identified on an open case, a plan of care must be developed and service referrals made.

If preferable, the permanency worker 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. 4, § 20; Form OHA 1394

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.

The plan of care should address the following:

• Medical care for the newborn
• Infant service/resource referrals plan (e.g., Community Health Nurse, Early Intervention, Infant Toddler Mental Health, WIC)

Services for the Parents or Other Caregivers

Citation: CW Proc. Man. Ch. 4, § 20; Form OHA 1394

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

The plan of care form should be incorporated in the discharge plan or other written document. Regardless of where the plan is documented, it should be developed prior to discharge from the hospital and can be used as a tool prior to the child's birth. The plan should do the following:

• Identify who participated in its development and note who is taking the lead for monitoring
• Identify people or organizations the parent can contact and include the contact information
• Address the following:
  • Medical care for the parent
  • Safe housing, food, basic needs
  • Safe sleep
  • Routine child care, if the parent is in school or employed
  • Emergency child care
  • Transportation
  • Parenting support (e.g., address parent's awareness of impact to infant and responsiveness to infant needs)
  • Parent service/resource referrals plan (e.g., alcohol and drug or mental health assessment/treatment, domestic violence)

Monitoring Plans of Safe Care

Citation: CW Proc. Man. Ch. 4, § 20

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.