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

Date: August 2019


Citation: CPS Pol. Man. § 2.3

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 suffer from withdrawal symptoms resulting from prenatal drug exposure or a fetal alcohol spectrum disorder.

'Neonatal abstinence syndrome' (NAS) refers to a group of problems 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 for 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 (FASD) 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. § 3.21

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 affected by alcohol, legal and/or illegal substance use or abuse, or experiencing withdrawal symptoms resulting from prenatal drug exposure. Health-care providers who are involved in the delivery or care of such infants are required to make a report to child protective services.

Assessment of the Infant and Family

Citation: CPS Pol. Man. §§ 3.21; 4.40

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 or an infant is suffering from withdrawal from a legal or illegal drug or prescribed medication (including drugs that treat addiction), or 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 results, if applicable, including type of drug for which the infant tested positive
  • The birth mother's drug test results, if applicable, including type of drug for which she tested positive
  • Information from the delivering obstetrician, nurse practitioner, mid-wife, or other qualified medical personnel as to the condition of the infant upon birth, including specific data as to how the in-utero drug 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
  • The names and ages of any siblings the infant may have, including any abuse, neglect or safety concerns regarding the siblings

Once 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 Health and Human Resources, including other adults that 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 infant's family to begin the assessment and implement a protection plan if needed.

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 worker, pediatrician, drug 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/doctors progress notes. The caseworker will assess child safety and determine if maltreatment has occurred. If maltreatment occurred and no other safety items are identified, a case will be opened, a family case plan completed, and appropriate services put in place to address the drug use and/or any other contributing factors. It is important for the worker to obtain information about the parents' interaction with the infant and any relevant statements the parents revealed to staff about the ability to properly care for the child.

Responsibility for Development of the Plan of Safe Care

Citation: CPS Pol. Man. § 4.40

CAPTA requires that children identified as being drug affected have a POSC. If the assessment indicates a case should be opened, the family case plan will become the POSC.

According to CAPTA, all drug-affected infants require a POSC, but not all infants identified as drug-affected are maltreated. An assessment needs to be completed to make that determination. For those infants who need a POSC because they are identified as drug affected (less than 1 year of age, test positive or show withdrawal symptoms, and the referral is from medical source), and if the assessment indicates a case should be opened (maltreatment has occurred and/or an impending danger has been identified), the family case plan is their POSC. If an assessment is completed and no maltreatment has occurred and no impending dangers have been identified, then only a POSC is required to be completed.

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. § 4.40

When the department has knowledge of a drug-affected infant, a referral to Birth to Three (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: CPS Pol. Man. § 4.40

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 and/or alcohol assessment and treatment
  • Medication-assisted treatment
  • Mental health assessment
  • Psychological or psychiatric 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. § 4.40

Upon the child's discharge from the hospital, the caseworker should visit the family's home to assess for safety and continue the assessment process. The worker should consider the parent's preparedness for the child, as evidenced by the presence of adequate baby supplies and sleeping arrangements for the infant. Intentions/beliefs the parents have regarding sleeping arrangements also should be discussed with all caregivers.

During the assessment process, it is important to assess the caregivers/parents' ability to parent the child and if the caregivers/parents have made strides to correct the substance abuse issues. This could include what methods of treatment intervention the parent chose and compliance with those treatments.

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 prescribing physician about the mother's illness and maintenance of the medication
  • Obtain records from the obstetrician to determine the mother's cooperation with prenatal appointments and to determine if the mother consulted about the effects of the medications to help to determine if the mother did what was in the best interest of her child
  • Assess if the mother has taken the medication as advised by a physician

The case should be evaluated every 90 days to determine if it can be closed.