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

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Definitions

Citation: Gen. Laws § 40-11-2; DCYF POSC Guidance Doc.

'Abused or neglected child' means a child whose physical or mental health or welfare is harmed, or threatened with harm, when his or her parent or other person responsible for his or her welfare fails to provide the child with a minimum degree of care or proper supervision or guardianship because of his or her unwillingness or inability to do so by situations or conditions such as the use of a drug, drugs, or alcohol to the extent that the parent or other person responsible for the child's welfare loses his or her ability to properly care for the child.

In policy: 'Affected by substance abuse' means the presence of any of the following in the mother:

  • Misuse of a legal substance
  • Use of an illicit substance

'Affected by withdrawal' means a group of behavioral and physiological features in the infant that follow the abrupt discontinuation of a substance that has the capability of producing physical dependence. No clinical signs of withdrawal in the neonate should be attributed to in utero exposure to alcohol or other drugs without appropriate assessment and diagnostic testing to rule out other causes.

'Fetal alcohol spectrum disorders' (FASD) means the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities, with possible lifelong implications.

'Substance-exposed newborn' (SEN) means a newborn who was exposed to alcohol and/or a controlled substance (illicit or prescribed) ingested by the mother in utero. This exposure may be detected at birth through a drug screen or through withdrawal symptoms.

'Neonatal abstinence syndrome' (NAS) means a group of signs and symptoms that sometimes occur in a newborn who was exposed to opiate drugs while in utero.

'Health-care provider' means any provider of health-care services involved in the delivery or care of infants and/or care of children.

'Plan of safe care' (POSC) means the document to be completed by the newborn health-care provider for each substance-exposed newborn at the time of discharge from the birth hospital.

Notification/Reporting Requirements

Citation: Gen. Laws § 40-11-6; DCYF POSC Guidance Doc.

When any physician, duly certified registered nurse practitioner, or other health-care provider is involved in the delivery or care of infants born with or identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or an FASD, he or she shall report the incident or cause a report thereof to be made to the Department of Children, Youth and Families (DCYF).

In policy: A child protective services (CPS) report must be made to the CPS Hotline for any substance-exposed newborn for whom there are concerns for child abuse or neglect, as defined in § 40-11-2. A report to the CPS Hotline is required in the following circumstances:

  • A newborn has a positive toxicology screen for maternal illegal, nonprescribed, and/or misused prescribed controlled substance(s).
  • A newborn has clinical signs or symptoms of drug withdrawal as the result of prenatal exposure to illegal, nonprescribed, or misused prescribed controlled substance(s), and/or due to undetermined substance exposure.
  • A mother of a newborn tests positive for an illegal or nonprescribed controlled substance and/or misused prescribed controlled substance and the infant has not tested positive.
  • A newborn is diagnosed with FASD.
  • There are any safety concerns.

Assessment of the Infant and Family

Citation: Gen. Stat. § 40-11-7; DCYF POSC Guidance Doc.

DCYF shall investigate reports of child abuse and neglect in accordance with DCYF rules in order to determine the circumstances surrounding the alleged abuse or neglect and the cause thereof. In the event that after investigation it is determined by DCYF that the child is being or has been abused or neglected but that the circumstances of the child's family or otherwise do not require the removal of the child for his or her protection, DCYF may allow the child to remain at home and provide the family and child with access to preventative support and services.

In policy: DCYF may receive a report to the CPS Hotline alleging drug and/or alcohol abuse by a woman during her pregnancy. An investigation is initiated during pregnancy only if there are specific allegations of abuse and/or neglect of existing children in the home. An investigation may not be initiated during pregnancy if there are no children in the home. However, the DCYF employs a system of alerting hospitals to pregnant women for whom there is a potential for child safety concerns after birth. A hospital alert is issued in the following circumstances:

  • There is a history of chronic substance use by one or both parents.
  • One or both parents has a history of indicated child abuse/neglect.
  • One or both parents has a child abuse/neglect conviction.
  • There are concerns about the safety of the child after delivery.

Responsibility for Development of the Plan of Safe Care

Citation: DCYF POSC Guidance Doc.

DCYF must identify infants at risk of child abuse and neglect as a result of prenatal substance exposure, ensure that a POSC is developed for these infants, and ensure the referral of these infants and affected caregivers to appropriate services. The Rhode Island Department of Health (RIDOH) is assisting in the State's efforts to implement POSCs.

A POSC must be completed by the newborn health-care team prior to discharge from the birth hospital for each substance-exposed newborn. Situations that require a POSC, but not a CPS report to the Hotline, include the following:

  • The mother is engaged in medication-assisted treatment for substance use disorder, and there are no safety concerns.
  • The mother is taking opioids as prescribed by her clinician, and there are no safety concerns.
  • The mother is taking any medication or combination of medications as prescribed by her clinician, and there are no safety concerns.

The POSC is provided to the newborn's caregiver at the time of newborn hospital discharge. A copy of the POSC must be documented in the newborn's hospital medical record and additional copies must be given to the newborn's primary care provider and to DCYF for all infants with an open case with DCYF. A parent or guardian may consent to release of a copy of the POSC to other treatment and service providers.

Services for the Infant

Citation: DCYF POSC Guidance Doc.

All substance exposed newborns must have a POSC at the time of discharge from the birth hospital. A POSC is developed at discharge by addressing supports in place for the health needs of the newborn and must include referrals to services and supports for the substance-exposed newborn.

Services for the Parents or Other Caregivers

Citation: DCYF POSC Guidance Doc.

A POSC is developed at discharge by addressing supports in place and substance use disorder treatment needs of the parent and/or caregiver. The POSC may include services such as home visitation, early intervention services, and recovery supports. A POSC must include referrals to services and supports for the caregiver affected by substance use. Examples of such services and supports include, but are not limited to, home visiting programs, early intervention services, and recovery supports.

Monitoring Plans of Safe Care

Citation: DCYF POSC Guidance Doc.

RIDOH is responsible for collecting data on POSCs and providing to the DCYF the aggregate data to submit to the Federal office of the Administration of Children and Families. Federal law requires information on POSCs to be submitted to the DCYF for data tracking purposes and reporting to the Administration for Children and Families. RIDOH is responsible for collecting information on POSC from Rhode Island birth hospitals and for aggregating and submitting these data to DCYF quarterly.

Data submitted from RIDOH to DCYF must include the number of SENs, including the number diagnosed with NAS and FASD prior to release from the birthing hospital, the number of POSCs completed, and the number and types of service referrals included on the POSCs.

DCYF, RIDOH, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and the Executive Office of Health and Human Services, with input from birthing hospital staff, will meet regularly to review the aggregate data on SENs and POSCs, the POSC process, and opportunities for system improvements to support families and ongoing interagency collaboration.