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

Definitions
Citation: Fam. Code § 261.001; Admin. Code Tit. 40, §§ 700.465; 707.455

The term 'abuse' includes the current use by a person of a controlled substance in a manner or to the extent that the use results in physical, mental, or emotional injury to a child.

In regulation: The term 'neglectful supervision' includes the prenatal use of alcohol or a controlled substance that was not lawfully prescribed by a medical practitioner, was lawfully prescribed as a result of the mother seeking out multiple health-care providers as a means of exceeding ordinary dosages or was not being used in accordance with a lawfully issued prescription. The pregnant mother is responsible for neglectful supervision under this section if the following apply:

• The mother knew or reasonably should have known she was pregnant.
• It appears that the mother's use endangered the physical and emotional well-being of the infant. It is not necessary that the infant actually suffer injury. 

For the limited purpose of this paragraph, the term 'endangered' means that the pregnant mother's use exposed the infant to loss or injury or jeopardized the infant's emotional or physical health. 'Endangered' includes, but is not limited to, consideration of the following factors:

• Evidence the mother extensively used alcohol or regularly or extensively used a controlled substance over the course of the pregnancy or in close proximity to the child's expected birth date
• Evidence that the mother has an alcohol or drug addiction
• Evidence that the infant was at a substantial risk of immediate harm from the mother's use of alcohol or a controlled substance

The term 'physical abuse' includes any of the following conditions that occur in an infant under age 1 because of the mother's prenatal use of alcohol or a controlled substance that was not lawfully prescribed by a medical practitioner, was lawfully prescribed as a result of the mother seeking out multiple health care providers as a means of exceeding ordinary dosages, or was not being used in accordance with a lawfully issued prescription, if the mother knew or reasonably should have known she was pregnant: 

• A physician's written diagnosis of physical manifestations of fetal alcohol syndrome or fetal alcohol effect, which includes alcohol-related birth defects and alcohol related neurodevelopmental disorder
• A physician's written opinion that the newborn was harmed from in utero exposure to alcohol or a controlled substance
• A physician's diagnosis of neonatal abstinence syndrome

Notification/Reporting Requirements
Citation: Fam. Code § 261.101

If a professional has reasonable cause to believe that a child has been abused as defined by § 261.001, the professional shall make a report no later than the 48th hour after the hour the professional first has reasonable cause to believe that the child has been or may be abused or neglected.

Assessment of the Infant and Family

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

Responsibility for Development of the Plan of Safe Care
Citation: CPS Pol. Man. § 1963.1

In policy: The Department of Family and Protective Services (DFPS) handles all cases involving an infant prenatally exposed to or affected by substances on a case-by-case basis. The Child Abuse Prevention and Treatment Act requires policies and procedures to address the needs of infants who have been exposed to substances. It also requires appropriate referrals to child protective services and other appropriate services while developing a plan of safe care (POSC) for the infant and the family. DFPS develops a POSC for all infants affected by or exposed to substance use. The plan is developed with input from the parents and other caregivers, as well as any professionals and agencies involved in care for the infant and the family.

Services for the Infant
Citation: CPS Pol. Man. § 1963.1

A POSC is designed to ensure the safety and well-being of the infant after release from the postnatal care of a provider (such as a hospital) by addressing the health needs of the infant.

Services for the Parents or Other Caregivers
Citation: Hlth. & Safety Code § 34.01581; CPS Pol. Man. § 1963.1

The Department of State Health Services, in collaboration with the Texas Maternal Mortality and Morbidity Review Committee, shall develop and implement initiatives to do the following:

• Improve screening procedures to better identify and care for women with opioid use disorder
• Improve continuity of care for women with opioid use disorder by ensuring that health-care providers refer the women to appropriate treatment and verify that the women receive the treatment
• Optimize health care provided to pregnant women with opioid use disorder
• Optimize health care provided to newborns with neonatal abstinence syndrome by encouraging maternal engagement
• Increase access to medication-assisted treatment for women with opioid use disorder during pregnancy and the postpartum period
• Prevent opioid use disorder by reducing the number of opioid drugs prescribed before, during, and following a delivery

Using existing resources, the department, in collaboration with the review committee, shall promote and facilitate the use among health-care providers of maternal health informational materials, including tools and procedures related to best practices in maternal health, to improve obstetrical care for women with opioid use disorder.

In policy: A POSC is designed to ensure the safety and well-being of the infant's family after release from the postnatal care of a provider (such as a hospital) by addressing the following:

• Health needs of the mother
• Treatment needs for a substance use disorder for the affected parent or caregiver, as applicable

Monitoring Plans of Safe Care
Citation: Gov’t. Code § 532.0204; CPS Pol. Man. § 1963.1

The Health and Human Services Commission shall collect hospital discharge data for recipients regarding treatment of a newborn child for prenatal exposure to alcohol or a controlled substance. The commission shall provide the data collected to the Department of Family and Protective Services.

In policy: A POSC monitors the family's use of community resources in accordance with State requirements for this monitoring.