Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - Wyoming
Definitions
Citation: Ann. Stat. § 35-2-1401(a); Code of Rules 049-0035-1
The term 'early intervention and education program' means a program that provides services for infants and children with developmental delays and disabilities.
The term 'patient care team' means a team of health-care providers, including one or more licensed health-care providers, who provide medical care services to a patient.
The term 'plan of safe care' (POSC) means a plan designed to ensure the safety and well-being of an infant with prenatal substance use exposure following the infant's release from the care of a health-care provider by addressing the health and substance use treatment needs of the infant and the affected family or caregiver.
In regulation: The term 'affected by withdrawal' means a group of behavioral and physiological features in an infant that follow the abrupt discontinuation of a substance that has the capability of producing physical dependence, determined through the use of appropriate assessment and diagnostic testing to rule out other causes.
The term 'affected family' means a family with a positive screen, toxicology, or self-disclosure of substance use of the pregnant or birthing individual during pregnancy.
The term 'fetal alcohol spectrum disorder' (FASD) means a group of conditions that can occur in a person who was exposed to alcohol before birth. These effects can include physical problems and problems with behavior and learning.
The term 'infant prenatally substance exposed' means when there is the presence of or self-disclosure of any substance use by the pregnant or birthing individual at any time during pregnancy.
Notification/Reporting Requirements
Citation: Code of Rules 049-0035-1; 049-0035-2
A member of the patient care team involved in the delivery or care of infants prenatally substance exposed shall notify the Department of Family Services (DFS) of the occurrence of those conditions of infants.
Patient care teams involved with the identification or delivery of a prenatally substance-exposed infant shall notify DFS, providing the following information:
- Name, phone number, and notifying agency or organization
- Month and year of the infant's birth
- Zip code for where the birth occurred
- The Infant's race and ethnicity
- Substance to which the infant was exposed
- Service referrals that were made for appropriate services
- Additional information as identified
Pursuant to § 14-3-205, patient care teams shall make a report to the DFS local field office when there are safety concerns related to abuse or neglect of the infant. An initial positive toxicology of the infant at birth is not indicative of abuse or neglect by itself; immediate safety concerns must accompany the positive toxicology.
Assessment of the Infant and Family
Citation: Code of Rules 049-0035-1; 049-0035-2
The term 'universal screening' means a preliminary evaluation that attempts to determine whether key features of substance use are present in a pregnant individual, utilizing an evidence-based screening questionnaire tool.
Patient care teams shall universally screen all pregnant patients during each trimester of pregnancy for substance use. Pregnant patients appearing for delivery, when it is unknown if a prenatal screening occurred, shall be screened for substance use.
Patient care teams shall engage the family, family support network, and medical professionals in a discussion regarding the needs of the infant and household members. The discussion shall include how each identified need will be addressed and by whom, including the following:
- Whether services are already being provided or are needed
- Circumstances in which the pregnant individual has been prescribed medication due to a physical illness or mental illness, including medications to treat substance use disorders
Patient care teams shall verify that the pregnant individual is doing the following:
- Adhering to the requirements of the treatment plan
- Taking the prescribed dose of medication at the prescribed schedule for the prescribed duration of therapy
- Refraining from using other substances
Responsibility for Development of the Plan of Safe Care
Citation: Ann. Stat. § 35-2-1401(b)-(d); Code of Rules 049-0035-2
When an infant is born with and identified, or identified prenatally, as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug or alcohol exposure, a member of a patient care team shall develop a POSC in cooperation with the infant's parents, families, or guardians with a priority of keeping the infant in the home as the safety and well-being of the infant allows. The plan must include the following objectives:
- Ensuring the safety and well-being of the infant
- Addressing the health and substance use treatment needs of the infant and affected family members or caregivers
- Ensuring that appropriate referrals are made for the infant and affected family members or caregivers upon discharge from the hospital or other health-care provider, including a referral to a local early intervention and education program
The POSC shall consider whether the infant's prenatal drug exposure occurred as a result of medication-assisted treatment or medication prescribed for the mother by a health-care provider and whether the infant's mother is or will be actively engaged in ongoing substance use disorder treatment that would mitigate the future risk of harm to the infant following discharge.
If applicable, a copy of the POSC shall be provided to the appropriate community partners involved in the infant's future care and included in the instructions for the infant upon discharge from the hospital or other health-care provider.
In regulation: Patient care teams shall initiate development of a POSC for pregnant patients who screen positive for substance use at the time of the positive screening. Patient care teams shall initiate referrals for the pregnant patient at the time of initial development and shall finalize and initiate the POSC after the infant's birth, prior to the infant's and parent's discharge from the birthing event.
Services for the Infant
Citation: Code of Rules 049-0035-1; 049-0035-2
The term 'referral' means the coordination of connecting infants and families with services to address their needs.
The written POSC documents the identified needs of the infant, including the following:
- Health care, as follows:
- Identification of a primary care provider
- Referral to specialty care
- High-risk follow-up care
- Safety of the infant with the caregivers
- Developmental screening and assessment
- Linkage to early intervention services
- Early care and education program
- A consistent and stable primary caregiver
Services for the Parents or Other Caregivers
Citation: Code of Rules 049-0035-1; 049-0035-2
The term 'family support network' means nonprofessional individuals identified by the family who assist the family in achieving safety, well-being, and success.
The term 'warm referral' means a person-centered connection, made in partnership with the affected family member or caregiver, to service providers that are able to meet the individual's needs.
The POSC documents the identified needs of the pregnant individual, including the following:
- Health care, as follows:
- Primary care provider
- Obstetrics and gynecological provider
- Specialty care provider
- Medication and pain management
- Feeding support for the infant
- Substance use treatment connection, which should include the following:
- Timely access
- Engagement, retention, and recovery supports
- Appropriate treatment, including, but not limited to, gender-specific, family-focused, accessible, medication-assisted, and trauma-responsive treatment
- Identifying and assisting the pregnant individual in accessing the appropriate assessments and treatment services
- Parenting/family support, as follows:
- Coordinated case management/home visits to assess or address infant care, parent and infant bonding, nurturing, pregnant individual's understanding of the special care needs of the infant(s) and ability to provide that care, parenting guidance and skill development, safe sleep practices, and maternal support
- Child care
- Benefits and eligibility determination, including, but not limited to, the following:
- Employment support
- Housing
- Transportation
- Child care assistance
- Social Security benefits
- Family support network
The POSC will also address the needs of father, other parent, or other family members, as indicated:
- Substance use disorder assessment and treatment.
- Health care, as follows:
- Mental health assessment and treatment
- Medication management
- Parenting skills (i.e., bonding, nurturing, understanding of the special care needs of the infant, and the ability to provide care, safe sleep practice, etc.)
- Protective factors, meaning the ability to meet the care and protection needs of the infant and any other children living in the home
The POSC should also address the needs of other children in the home, as indicated:
- Identification of a consistent pediatrician/healthcare provider
- Safety with the caregivers
- Developmental screening and assessment
- Linkage to early intervention services
- Early care and education program
Monitoring Plans of Safe Care
Citation: Ann. Stat. § 35-2-1401(e); Code of Rules 049-0035-1
The patient care team shall report the total number of infants and families for whom a POSC has been developed to the Department of Family Services pursuant to the Comprehensive Addiction and Recovery Act of 2016 (P.L. 114-198).
In regulation: The 'Notification Online Portal' is the online notification pathway established or approved by the department for the purpose of collecting the required data. The 'Plan of Safe Care Collaborative' is the community, regional, or district-level multidisciplinary team that oversees developed POSCs.
The department shall collect and report the following data:
- The aggregated rate of births in the State of infants affected by substance abuse or withdrawal symptoms or FASD
- The number of infants identified for whom a POSC was developed and for whom a referral was made for appropriate services
- The number of infants to whom any of the following apply:
- Experienced removal associated with parental substance use
- Experienced removal and were reunified with parents, and the length of time between the removal and reunification
- Were referred to community providers without a child protection case
- Received services while in the care of their birth parents
- Received postreunification services within 1 year after reunification occurred
- Experienced a return to out-of-home care within 1 year after reunification
The department shall develop and implement a State monitoring system regarding the implementation of POSCs to determine whether and in what manner local entities are providing referrals to and delivery of appropriate services for the infant and affected family or caregivers.