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

Definitions
Citation: Ann. Stat. § 48.02(1), (17m)

The term 'abuse,' when used in referring to an unborn child, means serious physical harm inflicted on the unborn child, and the risk of serious physical harm to the child when born, caused by the habitual lack of self-control of the expectant mother of the unborn child in the use of alcohol beverages, controlled substances, or controlled-substance analogs exhibited to a severe degree.

'Special treatment or care' means professional services that need to be provided to a child or their family to protect the well-being of the child, prevent the placement of the child outside the home, or meet the special needs of the child. 'Special treatment or care' also means professional services that need to be provided to the expectant mother of an unborn child to protect the physical health of the unborn child and of the child when born from the harmful effects resulting from the habitual lack of self-control of the expectant mother in the use of alcohol, controlled substances, or controlled-substance analogs exhibited to a severe degree. This term includes, but is not limited to, medical, psychological, or psychiatric treatment; alcohol or other drug abuse treatment; or other services that the court finds to be necessary and appropriate.

Notification/Reporting Requirements
Citation: Ann. Stat. §§ 48.981; 146.0255; 146.0257

Mandatory reporters are required to report the facts and circumstances indicating abuse of an unborn child to the Department of Children and Families, a county child welfare department, or a licensed child welfare agency under contract with the department.

If the results of a test for controlled substances indicate that the infant does have controlled substances in their bodily fluids, the physician shall report the occurrence of that condition in the infant to the agency that is responsible for conducting child abuse and neglect investigations, and that agency shall offer to provide or arrange for the provision of services and treatment for the child and the child's mother.

The physician who performs the test shall provide the infant's parents or guardian with all the following information:

• A statement of explanation concerning the test that was performed, the date of performance of the test, and the test results
• A statement of explanation that the test results of an infant must be disclosed to a child welfare agency if the test results are positive

If a physician diagnoses that an infant has fetal alcohol spectrum disorder (FASD), the physician shall report that diagnosis to the agency that is responsible for conducting child abuse and neglect investigations, and that agency shall offer to provide or arrange for the provision of services and treatment for the infant and the infant's mother as provided under § 46.238.

A physician who performs an evaluation shall provide the infant's parents or guardian with the following information:

• An explanation concerning the evaluation that was performed, the date of that evaluation, and the diagnosis resulting from that evaluation
• An explanation that the results of the evaluation must be disclosed to an agency if the evaluation indicates a diagnosis of FASD

Assessment of the Infant and Family
Citation: Ann. Stat. §§ 146.0255; 146.0257; Policy Memo # 2004-12

Any hospital employee who provides health care, social worker, or intake worker may refer an infant or an expectant mother of an unborn child to a physician for testing of the bodily fluids of the infant or expectant mother for controlled substances, if the hospital employee, social worker, or intake worker suspects that the infant or mother has controlled substances in their bodily fluids because of the use of controlled substances by the mother while she was pregnant. The physician may test the infant or expectant mother to ascertain whether or not the infant has controlled substances in the bodily fluids of the infant or mother if the physician determines that there is a serious risk that there are controlled substances in the bodily fluids of the infant or mother because of the use of controlled substances by the mother while she was pregnant and that the health of the infant may be adversely affected by the controlled substances.

If a hospital employee who provides health care, social worker, or intake worker suspects that an infant has FASD, the hospital employee, social worker, or intake worker shall refer the infant to a physician for an evaluation to diagnose whether the infant has that disorder. If a physician determines that there is a serious risk that an infant has FASD, the physician shall evaluate the infant to diagnose whether the infant has that disorder.

In policy: If the referral is accepted for assessment under § 46.238, the following information must be gathered and documented:

• The infant's general functioning and development, including the effects of illegal substances on the infant
• The parents' individual functioning, including communication, coping, problem solving, life management, control of emotions, use of alcohol or other substances, mental health functioning, sociability and relationships with others, self-concept, etc.
• If there are other children in the home, the parents' parenting practices (discipline, nurturing, understanding of child's needs and capabilities, expectations of the child, satisfaction with a parenting role, etc.)
• If there are no other children in the home, the parents' capacity and commitment to parent (understanding of infant's special needs and plans already made to address them, general day-to-day plan for caring for the infant, etc.)
• The family's functioning, strengths, and current stresses (roles and boundaries, communication, decision making, relationships, integration into the community, power distribution, presence or absence of domestic violence, organization and stability, demographics, etc.) 

The above information must be used to assess safety. As the fact that the mother has used illegal substances is apparent, the assessment must include a special focus on her current use of illegal substances and the impact that will have on the infant's care.

Responsibility for Development of the Plan of Safe Care
Citation: Policy Memo # 2004-12

The purpose of this policy is to assess the safety of an infant born with controlled substances or controlled substance analogs in their system and to develop a plan of safe care (POSC) for that infant. This policy applies to an infant born with controlled substances or controlled substance analogs in their system, as determined by a physician pursuant to § 146.0255 when information does not indicate that the child has been abused or neglected or threatened with abuse or neglect. This policy does not apply to an infant born with controlled substances or controlled substance analogs in their system where there are reports of alleged maltreatment to the infant subsequent to birth. Such cases are to be handled as reports of alleged maltreatment under § 48.981.

Child protective services (CPS) will accept reports of an infant identified at birth as having controlled substances or controlled substance analogs in their system, pursuant to § 46.238, and assess the safety of the infant. CPS will develop a POSC that reduces risk to the child and supports a safe environment, either an agency-managed safety plan or a referral to appropriate preventive community services or determine that the family has in place a POSC for the infant. The report is screened in as a child welfare services intake, and no decision regarding substantiation is made, as the report is made under § 46.238, not under § 48.981.

Services for the Infant
Citation: Ann. Stat. § 46.238

If an agency, as defined in § 48.981(1)(ag), receives a report under § 146.0255(2) or 146.0257(2) that an infant was born to a mother who abused controlled substances, controlled-substance analogs, or alcohol and that agency is a county department or a licensed child welfare agency under contract with that county department, the agency shall offer to provide appropriate services and treatment to the infant and the infant's mother.

Services for the Parents or Other Caregivers
Citation: Ann. Stat. § 51.42; 51.46; Policy Memo # 2004-12

Community alcoholism and drug abuse services must ensure that priority for services is given to pregnant women who suffer from alcoholism or alcohol abuse or are drug dependent.

For inpatient or outpatient treatment for alcohol or other drug abuse, the first priority for services that are available in privately operated facilities, whether on a voluntary or involuntary basis, is for pregnant women who suffer from alcoholism, alcohol abuse, or drug dependency.

In policy: If the infant is determined to be safe, the agency should refer the family to appropriate community resources and assist the family in accessing those resources unless the family refuses such assistance. The activities associated with referral to community resources should be documented in the case record.

Monitoring Plans of Safe Care

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