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

Definitions
Citation: Admin. Pol. & Proc. § 14.9; CPS Tasks Man.

In policy 14.9: 'Fetal alcohol spectrum disorders' (FASD) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with FASD has a mix of these problems.

'Neonatal abstinence syndrome' (NAS) is a condition in which a baby has withdrawal symptoms after being exposed to certain substances. Many times, the baby is exposed when the mother uses substances such as medications or illicit drugs during pregnancy, and after the baby is born (and separated from the mother's body), the baby goes through withdrawal because it is no longer receiving the substances.

Medications that may cause withdrawal include those known as opioids (painkillers) or benzodiazepines (which help with anxiety or sleep). Illegal drugs such as cocaine may also cause withdrawal. Withdrawal can occur when a mother is using a medication as prescribed (e.g., a mother who is receiving legally prescribed medication for pain or addiction); when a mother is misusing a prescription medication (e.g., using the medication too much or too often or taking a medication not prescribed to her); or the use of illegal drugs.

From the manual: Severe forms of the 'drug-exposed child' allegation include, but are not limited to, the following:

• Infants born with a diagnosis of FASD
• Infants born with a diagnosis of NAS where the diagnosis is not based on the mother's prescribed and appropriately followed medication-assisted treatment

Notification/Reporting Requirements
Citation: Admin. Pol. & Proc. § 14.9

In policy 14.9: Referrals received for infants (birth to 12 months of age) born with and identified as being affected by substance abuse, withdrawal symptoms resulting from prenatal exposure from the use of illegal drugs, the misuse of legal drugs or chemical substances, or diagnosed with NAS or FASD will be identified as a Federal Comprehensive Addiction and Recovery Act of 2016 (CARA) case when this information is reported or confirmed by or on behalf of a medical provider. These infants must have a POSC to include services that ensure the safety and well-being of infants.

Assessment of the Infant and Family
Citation: CPS Tasks Man.

All children, youth, and families deserve a strength-based and holistic approach to assessment that promotes a comprehensive understanding of their issues and service needs. Clients identified with substance abuse issues and their families should receive a comprehensive assessment to determine the safety, strengths, and services needed. Assessments of clients' needs and progress should be ongoing to address any change.

For drug-exposed newborns, parents should be interviewed about the following issues:

• Any medications being taken, the purpose of the medication, and the name of the prescriber
• The parent's history of drug use, the type of drug, and frequency of use
• Whether the parent tested positive for any substance during pregnancy
• Whether the parent is aware of any medical or physical complications that the baby has due to drug exposure
• How prepared the parent is to care for the child (crib, car seat, diapers, formula, clothing, family support, etc.)
• The parent's plan for when they are released from the hospital (living arrangements, transportation, medical care, etc.) 

Medical professionals should be interviewed about the following: 

• Whether the mother tested positive for a drug at admission for the child's delivery
• Whether the mother was using any prescription medications that would have caused her to test positive
• Whether the baby tested positive for drugs at birth:
  • If so, what drug?
  • Has a meconium or umbilical cord been collected? What are the results, if known?
• Whether the provider is aware of any medical or physical complications for the baby due to drug exposure:
  • Is the newborn showing any signs of withdrawal?
  • What are the newborn's symptoms?
  • What treatment is being given due to these symptoms?
• Whether the mother is bonding well with this child
• When the mother and baby will be released from the hospital
• If the child now has special needs because of the drug exposure, whether the mother is aware and willing to get prepared to care for the child medically

Responsibility for Development of the Plan of Safe Care
Citation: CPS Tasks Man.

A noncustodial family permanency plan (NCPP) is appropriate for service planning and next steps. An NCPP should be completed when the family is being asked to complete and comply with services or next steps. An NCPP should always be completed when a case meets the criteria for CARA.

The caseworker should involve and engage the family in the development of the plan, including the family's entire support system. When developing NCPPs for drug-exposed child concerns/allegations, a return-to-use prevention plan needs to be included in the plan.

Services for the Infant
Citation: CPS Tasks Man.

A home visit is completed prior to the infant's discharge from the hospital or, at minimum, the day of the infant's discharge to ensure the safety of the home and safe sleep. Safe sleep is reviewed with the family to ensure understanding. A safe sleep assessment is completed with the parent or caregiver. The safe sleep space is observed by the case manager. If safe sleep accommodation is unavailable or is not adequate, a pack-and-play will be provided by the Department of Children's Services to the family prior to the case manager leaving the home.

Services for the Parents or Other Caregivers
Citation: Ann. Code § 33-10-104(f); CPS Tasks Man.

A pregnant woman referred for drug abuse or drug dependence treatment at any treatment resource that receives public funding shall be a priority user of available treatment. The Department of Mental Health and Substance Abuse Services shall ensure that family-oriented drug abuse or drug dependence treatment is available, as appropriations allow. A treatment resource that receives public funds shall not refuse to treat a person solely because the person is pregnant if appropriate services are offered by the treatment resource.

If during prenatal care, the attending obstetrical provider determines no later than the end of the 20th week of pregnancy that the patient has used prescription drugs that may place the fetus in jeopardy, and drug abuse or drug dependence treatment is indicated, the provider shall encourage counseling, drug abuse or drug dependence treatment, and other assistance to the patient.

From the manual: Families affected by substance abuse must be given adequate opportunity to address their challenges and obtain support to strengthen their ability to achieve recovery, stability, and healthy relationships. Communication and sharing of information about families impacted by substance abuse should be done in a respectful manner and in compliance with the family's rights to confidentiality. The child welfare system should work with other systems and providers to remove barriers and create systems of care that effectively respond to the complex needs of families and promote healthy and safe families.

Monitoring Plans of Safe Care

This issue is not addressed in the statutes and regulations reviewed.