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

Definitions 
Citation: CPS Pol. Man. §§ 1.9; 2.8

In policy: The term 'drug-affected infants' describes infants referred by medical staff, including hospital social workers, who are less than 1 year old, who test positive for legal or illegal substances or prescribed medication, or who suffer from withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder.

'Neonatal abstinence syndrome' refers to a group of symptoms that occur in a newborn who was exposed to addictive illegal or prescription drugs while in the mother's womb.

A 'plan of safe care' (POSC) is a plan to ensure the safety and well-being of the infant born and identified as being affected by legal or illegal substance abuse, withdrawal symptoms, or testing positive for substances or a fetal alcohol spectrum disorder following release from the care of health-care providers by addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver. This includes referrals to and delivery of appropriate services for the infant and affected family or caregiver.

Notification/Reporting Requirements
Citation: CPS Pol. Man. § 2.8

The Child Abuse Prevention and Treatment Act (CAPTA) is a key piece of Federal legislation that guides child protective services. This legislation requires that child protective services and other community service providers address the needs of newborn infants who have been identified as being exposed to or affected by alcohol, legal, or illegal substances or who are experiencing withdrawal symptoms resulting from prenatal substance exposure. Health-care providers or medical professionals who are involved in the delivery or care of such infants are required to make a report to child protective services. Hospital social workers who report are acting on behalf of the hospital or birthing center and should be considered medical professionals in this capacity.

Assessment of the Infant and Family
Citation: CPS Pol. Man. §§ 2.8; 3.17

When a report is received specifically from a medical professional, including a hospital social worker, indicating that an infant was born testing positive for a legal or illegal drug or prescribed medication, is suffering from withdrawal from a legal or illegal drug or prescribed medication (including drugs that treat addiction), or has symptoms indicating fetal alcohol spectrum disorder, the child will be identified as a drug-affected infant.

For reports received from medical professionals of drug-affected infants, the intake assessment worker will gather the following information: 

• The name and address of the medical facility where the child was delivered
• The infant's drug test results, if applicable, including the type of substance for which the infant tested positive
• The birth mother's drug test results, if applicable, including the type of substance for which the mother tested positive, as well as any medication the mother was administered prior to and during delivery
• Information from the delivering obstetrician, nurse practitioner, midwife, or other qualified medical personnel as to the condition of the infant upon birth, including specific data as to how the in-utero substance or alcohol exposure has affected the infant (e.g., withdrawal, physical and/or neurological birth defects)
• The infant's birth weight and gestational age
• The extent of prenatal care received by the birth mother
• Information regarding any substance use disorder treatment or medication-assisted treatment (MAT) that the parent may be involved with or has accessed previously for substance use disorder treatment
• The names and ages of any siblings the infant may have, including any abuse, neglect, or safety concerns regarding the siblings

Once a referral regarding a drug-affected infant has been received, the caseworker will review the family's available records and history of past involvement with the Department of Human Services, including other adults who would be considered caregivers and residing in the household. Since most children are released within 24 hours of birth, the caseworker must meet face-to-face with the infant and the infant's family to begin the assessment and implement a protection plan if needed. The caseworker should obtain identifying information about the father. 

The caseworker should thoroughly assess the family, gathering information from the parents and other pertinent collaterals. Suggested collaterals are, but should not be limited to, hospital staff, social workers, pediatricians, substance use disorder counselors, therapists, and teachers. Hospital records for both the mother and child should be obtained. This could include toxicology reports and withdrawal scores of the infant and nurses' or doctors' progress notes.

The caseworker shall obtain information about the parents' interaction with the infant and any relevant statements the parents revealed to staff about the parents' ability to properly care for the child. Upon the child's discharge from the hospital, the caseworker should visit the family's home to assess for safety and continue the initial assessment process. The worker should consider the parents' preparedness for the child as evidenced by the presence of adequate baby supplies and sleeping arrangements. The intentions or beliefs the parents have regarding sleeping arrangements should also be discussed with all caregivers.

The caseworker will assess child safety and determine if maltreatment has occurred. If maltreatment has occurred and no other impending safety threats are identified, a case will be opened, and appropriate services will be put in place to address the substance use disorder or any other contributing factors. The case plan will serve as the POSC.

Responsibility for Development of the Plan of Safe Care
Citation: CPS Pol. Man. § 3.17

All infants who are exposed to or test positive or exhibit withdrawal symptoms due to legal or illegal substances, alcohol, or prescribed medication, including medications used to treat addiction, require a POSC according to CAPTA. However, not all infants identified as such are maltreated. An assessment needs to be completed to make that determination. For those infants who need a POSC due to being identified as exposed to or test positive or exhibit withdrawal symptoms due to legal or illegal substances, alcohol, or prescribed medication, and if the assessment indicates a case should be opened due to maltreatment occurring or an impending safety threat being identified, the ongoing assessment and case plan is their POSC.

A POSC is not to be viewed concretely as a singular document. It is fluid and functions on a continuum. It will change as the needs of the child and family change. The responsibility of the department is to complete an assessment after the receipt of the referral when the child is born drug-affected, determine the needs of the family, and provide the appropriate services.

Services for the Infant
Citation: CPS Pol. Man. § 3.17

When the department has knowledge of a drug-affected infant, a referral to Birth to Three (an early intervention program) must be initiated and clearly documented.

Needs will vary from family to family, but CAPTA requires that the department address substance use disorders, other mental health needs, and the medical needs of the infant.

Services for the Parents or Other Caregivers
Citation: Ann. Code § 9-5-24; CPS Pol. Man. § 3.17

Substance abuse treatment or recovery service providers that accept Medicaid shall give pregnant women priority in accessing services and shall not refuse access to services solely due to pregnancy, as long as the provider's services are appropriate for pregnant women.

In policy: Examples of interventions that may be necessary for the family include, but are not limited to, the following: 

• Protection plan, safety plan, and safety services
• Drug or alcohol assessment and treatment
• Medication-assisted treatment
• Mental health assessment
• Psychological evaluation
• Counseling
• Alcoholics Anonymous or Narcotics Anonymous
• Birth to Three services
• Right from the Start
• Home visitation
• Medical services
• Education on safe sleep practices and drug-affected infant needs

Monitoring Plans of Safe Care
Citation: CPS Pol. Man. § 3.17

In situations where the mother has been prescribed medication due to a physical illness or mental illness, including medications to treat addiction, it is very important for the caseworker to do the following:

• Obtain documentation from the mother's medical or mental health providers regarding prescribed medications
• Review records and consult with the mother's treatment team regarding adherence to a prescribed medication
• Obtain records and consult with the mother's obstetrician to determine the mother's cooperation with prenatal appointments, if available
• Obtain confirmatory lab testing results when a urine drug screen is requested