Ky.gov
Effective: 6/24/2026

G1.16 Working with Families Affected by Substance Misuse

Legal Authority

Introduction

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​The SSW may encounter families affected by substance misuse during all phases of intervention. This section of SOP provides guidance on how best to serve the affected children and families throughout the duration of services. 


Practice Guidance

Additional context: 
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  • Substance use disorders (SUD) are patterns of symptoms resulting from the use of a substance, which the individual continues to take despite experiencing problems as a result. Substance use disorders span a wide variety of problems arising from substance use and cover eleven (11) different criteria:
    • Taking the substance in larger amounts or for longer than the individual intended;
    • Wanting to cut down or stop using the substance but not able to do so;
    • Spending a lot of time getting, using, or recovering from use of the substance;
    • Cravings and urges to use the substance;
    • Not managing to do what the individual should at work, home or school, because of substance use;
    • Continuing to use, even when it causes problems in relationships;
    • Giving up important social, occupational, or recreational activities because of substance use;
    • Using substances again and again, even when it puts the individual in danger;
    • Continuing to use, even when the individual knows they have a physical or psychological problem that could have been caused or made worse by the substance;
    • Needing more of the substance to get the effect the individual wants (tolerance); or
    • Development of withdrawal symptoms, which can be relieved by taking more of the substance.
  • Fetal Alcohol Spectrum Disorder (FASD) refers to a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a combination of these problems. 
  • Neonatal Abstinence Syndrome (NAS) is the result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. This includes any of the adverse consequences in the newborn of exposure to addictive or dangerous intoxicants during fetal development. The consequences include, but are not limited to, preterm delivery, intrauterine growth retardation, asphyxia, low birth weight, drug withdrawal symptoms after delivery, behavioral, psychiatric, and learning disabilities later in life.
Values and Best Practice: 
  • Collaboration and communication among all service providers involved is needed to achieve successful outcomes for the family. No single agency has the resources or information to address the full range of needs of the affected children and their families.​
  • Decisions should be made and shared in a timely manner with professional reporting sources, especially with birthing hospitals in substance-affected infant cases; 
  • Assessments during all phases cannot be limited to assessment of the parent's caregiving while sober, and must include the degree to which the parent is impaired in terms of day-to-day living and functioning;
  • The frequency of contact with clients and service providers may need to increase beyond the minimum as established in SOP C5.7 SSW's Ongoing Contact with the Birth Family and Child​ and SOP ​C7.21 SSW's Ongoing Contact with the Child and Family, Including the Medically Complex Child​ , depending on case circumstances; and
  • It is important to recognize that in medication-assisted treatment (MAT), prescribed medication could be lifesaving and is an acceptable form of treatment, but it ​​​is only a piece of treatment and should be used in conjunction with additional services. 
  • Alcohol, cannabis, and other substances cause significant changes in brain chemistry, which affect a person’s mood, thinking, behavior, and perception. It can be difficult for a person to follow through on scheduling and keeping appointments; therefore, it is essential that SSWs assist families in making and keeping appointments​​ or identify a responsible person, such as an appropriate family member/friend or community service provider, to assist the family.
  • In addition to screening for substance misuse when indicated, it is important to assess for other service needs as well, including;
    • Referral of pregnant women and mothers who have recently given birth​ to appropriate and timely prenatal and follow-up postnatal medical care, including MAT or other medications as prescribed by treatment providers. This is also a good time to discuss birth control methods to begin after the child's birth. 
    • The family is following up with post-delivery medical appointments for the infant and follows any subsequent recommendations. 
    • The family's parenting skills and developmental expectations for the child, and referral to appropriate classes or support systems, i.e., HANDS or other local community programs.
    • Appropriate nutrition for the child, i.e., formula or breastfeeding, and referral to treatment providers for recommendations regarding breastfeeding mothers who are prescribed MAT or other medications. 
    • Substance misuse treatment is accompanied by a mental health assessment for treatment of the parent's underlying issues that resulted in the substance misuse.
    • Appropriate support for the family, both personal and community programs that can assist, if needed. 
    • The family's basic needs are met, and referral to community programs that can assist, if needed.
  • KY-Moms MATR helps expectant Kentucky mothers who are at risk of using alcohol, tobacco, and other drugs to reduce harm to their children from their substance use​ during and after pregnancy. Call (800) 374-9146 or visit the Department of Behavioral Health, Developmental, and Intellectual Disabilities website. 
  • The Substance Exposed Infant Reporting is a guide for the SSW to use when speaking with the delivering hospital’s medical staff regarding a substance-affected infant. The checklist can be used during any phase of interaction with the family.
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Plans of Safe Care (POSC) 

For cases involving an infant born identified as substance-affected, including withdrawal symptoms resulting from prenatal drug exposure or FASD, federal requirements indicate that the worker develop a POSC for the family (CAPTA 106(b)(2)(B)(ii) and (iii)). The child welfare agency will use existing continuous quality improvement (CQI) processes, including collaboration with partner agencies, to monitor local development of POSC, referrals to services, and the provision of appropriate services for infants and affected families or caregivers.

The identification of a substance-affected infant may occur during any stage of involvement, including at birth or later during the infant’s development and/or as symptoms manifest. The POSC addresses actions and services for the infant and family’s needs, and these needs must be incorporated into the safety plan, prevention plan, case plan, or aftercare plan in accordance with the best practice described in SOP C4.1 CPS Safety Planning, SOP C4.2 CPS Prevention Planning, SOP C4.3 CPS Aftercare Planning, SOP C5.4 Initial In-Home Case Planning Conference. 

For detailed information regarding development of the POSC, please see SOP C3.9 Plan of Safe Care (POSC) and the Impacts of Parental Substance Use in Early Childhood​-

Procedure

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The SSW :

  1. Thoroughly assesses throughout the life of the case, parental functioning both when sober and when impaired, including day-to-day living and functioning, and verifies that all medications, including but not limited to prescription, over-the-counter, and any other potentially harmful substances, are stored securely and out of reach of children. During the visit, the caseworker will discuss the importance of safe storage practices with caregivers, including the risks of accidental ingestion and the need to keep substances in child-resistant containers or locked cabinets, separate from food, and with original labels intact;
  2. Documents the household’s storage arrangements and, if harmful substances are found to be accessible to children, will collaborate with the family to develop a safety plan and implement corrective measures;
  3. Requests a signed release of information for treatment providers, as most providers require a specific form before disclosing information;
  4. Makes timely and direct personal contact with treatment providers before completing any referral for assessment or drug testing and ensures the treatment provider is aware of any case concerns, including any relevant criminal charges and the reason for referral; 
  5. Requests an initial SUD assessment/testing as well as follow-up services as determined by the ongoing assessment, throughout the life of the case; 
  6. Refers the individual to a SUD assessment regardless of the results of a drug test;
  7. Discusses the results of the assessment, including any follow-up recommendations, with the evaluator;
  8. Ensures that a safety and/or prevention plan includes specific steps related to the caregivers’ high-risk behaviors and safety of the child in the event of return to use and a plan for safe sleep for infants in the home, utilizing guidance and resources in SOP C3.8 Safe Sleep;
  9. Increases the frequency of contact with treatment providers and family members based on the case-specific need, specifically when there is an indication of return to use or high stress times that may trigger return to use;  
  10. Reports any concerns to the treatment provider regarding the caretaker’s functioning or ability to care for the child. (i.e., the caretaker is nodding off inappropriately, slurring words, appears to be over- or under-medicated, etc.);
  11. Assesses if the caretaker is taking medication as prescribed, which could include, but is not limited to, any prescription narcotics, medicinal cannabis, or other mind-altering substances. SSW will assess and document how the family currently ensures adequate supervision during use.  SSW will also use the opportunity to safety plan with the family if their current plan is not adequate (by counting pills or medication strips in the presence of SSW);
  12. Consults with any treatment or medication provider to incorporate specific treatment information into the child welfare assessment and case planning, including but not limited to:
    1. Safety of child (i.e., what are the effects of the medication on the caretaker’s ability to function daily and care for the child, safe storage of medications). Do not assume the treatment provider recognizes or considers the safety of the child while in the caretaker’s custody;
    2. Medication management (i.e., what type of medication is prescribed, what phase of treatment);
    3. Recommendations for follow-up treatment (i.e., inpatient, outpatient, AA/NA, length of treatment, etc.);
    4. Provider recommendation for mental health treatment. Best provider practice recommends that mental health treatment accompany medication management;
    5. Verification of medication doses (i.e., in the office or self-administered take-home);
    6. Compliance with treatment programs;
    7. Drug test results, both positive and negative, completed through the treatment program; 5 and
    8. Treatment discharge planning, including an appropriate aftercare plan if the caretaker is continuing MAT after case closure.
  13. Works with service providers regarding recommendations for safe sleep and breastfeeding safety, as well as tools for caretakers of neonatal abstinence syndrome (NAS) infants;
  14. Ensures that a treatment plan from any provider is incorporated into any safety plan, prevention plan, case plan, and/or aftercare plan completed for the family;
  15. Ensures that all caregivers (including parents or anyone providing supervision or care) are aware of the risks of accidental drug exposure for children;  
  16. Includes information from the treatment provider in the assessment and any case plans developed on behalf of the family;
  17. Relies on treatment providers for medication recommendations, and does not make medication recommendations to individuals;
  18. Does not make recommendations to the court regarding treatment;
  19. Does not take a punitive approach concerning return to use or treatment plan infractions, such as withholding parent/child visits;
  20. Does not set conditions on visitation that aren’t tied to a specific safety threat (i.e., changing unsupervised to supervised, location from out-of-office to in-office);
  21. Does not expect tapering of the MAT dose or an end-date of treatment;
  22. Does not require, or recommend, that the court necessitate tapering of the MAT dose or an end-date of treatment;
  23. Recognizes that some individuals will return to use and:
    1. If return to use occurs, SSW assesses the situation by talking to the individual, treatment provider, and any other collaterals;
    2. Assesses the risk to the child in the home; and
    3. Offers additional support to stabilize the situation if possible.
  24. Refers caregivers struggling with SUD or alternate caregivers to appropriate supportive services, including, but not limited to:
    1. HANDS;
    2. KY-Moms MATR; or
    3. Other services appropriate for providing care for infants experiencing withdrawal.
  25. Ensures appropriate designation of a case involving a substance-affected infant using the correct subprogram in the central intake screens to permit reporting of the number of substance-affected infants reported, and for whom a POSC was developed, and the number of infants for whom a referral was made for appropriate services. 
  26. Reports any concerns regarding treatment providers not following guidelines, or prescribing medications inappropriately, or to a large volume of people to the Kentucky Board of Medical Licensure at (502) 429-7150 or http://kbml.ky.gov/Pages/index.aspx;
  27. Immediately consults with FSOS to discuss the discontinuation of the safety and /or prevention plan when the safety threats requiring the provisions within the safety and/or prevention plan have been mitigated before the fourteen (14) working day expiration of the plan, and:
    1. If it is determined that the safety plan should be discontinued before the expiration date on the safety plan, the agency will inform the family and other involved individuals within forty-eight (48) hours, by phone call, that the safety/prevention plan will be discontinued before the expiration date. If the family is not available by phone within forty-eight (48) hours, SSW will send a notification by mail or conduct a home visit.
  28. Completes a face-to-face interview with the parent/caregiver within forty-eight (48) hours if the safety or prevention plan needs to be renegotiated based on safety threats or risks to the child(ren), documents the communication regarding renegotiation in the assessment and documentation tool (ADT), and files the written notification (if applicable) in the case file; and
  29. Continues to make efforts to engage adult clients throughout the life of the case until a waiver of reasonable efforts is granted or case closure occurs, maintaining the frequency and quality of contact and working to minimize any resistance to treatment services.

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Documents

Revisions

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