Best practice in cases related to substance misuse requires that:
- Decisions are made and shared timely with professional reporting sources—especially with birthing hospitals in substance-affected infant cases;
- Assessments (investigative and ongoing) 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;
- Regular ongoing contact with services providers is vital to completing the global risk assessment;
- The frequency of contact with clients and services providers may need to increase beyond the minimum as established in SOPs 3.10 and 4.24 depending on case circumstances; and
- The worker must continue to make efforts to engage adult clients through the life of the case until a waiver of reasonable efforts is granted or case closure occurs. Worker should maintain frequency and quality of contacts and work to minimize any resistance to treatment services.
It is important to recognize that in medication-assisted treatment (MAT), prescribed medication could be lifesaving and is an acceptable form of treatment but is only a piece of treatment and should be used in conjunction with additional services.
Appropriate service matching includes, but is not limited to assessment of the following:
- 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 supports 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.
Plans of Safe Care (POSC)
For cases involving an infant born identified as substance affected, including withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder (FASD), federal requirements require that the worker develop a POSC for the family (CAPTA 106(b)(2)(B)(ii) and (iii)). The plan should go beyond immediate safety threats to address the health and developmental needs of the affected infant and the caretaker’s need for treatment related to substance misuse and/or mental health. Additionally, it should identify the services and supports the caretaker needs to strengthen his or her capacity to nurture and care for the infant. To ensure safety of the infant, it should also incorporate a plan of safe sleep; and a plan for the care of the infant, and any other children, in the event of a return to use. The child welfare agency will use existing continuous quality improvement (CQI) processes, which includes collaboration with partner agencies, to monitor local development of POSC, referrals to services, and appropriate services to infants and affected family 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 best practice described in SOP 7.2 CPS Safety Planning, SOP 7.4 CPS Prevention Planning, SOP 7.6 CPS Aftercare Planning, SOP 3.4 Initial In Home Case Planning Conference, SOP 3.13 Ongoing Case Planning, SOP 4.17 Preparation for and Completion of the Ten Day Conference, SOP 4.18 Ongoing Case Planning [OOHC], and SOP 4.36 Case Closure and Aftercare Planning.
Alcohol and substances cause significant changes in brain chemistry, which affects 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 with making and keeping appointments or identify a responsible person, such as an appropriate family member/friend or community service provider, to assist the family.