3.4 Intakes Involving Substance Use or Abuse, Prenatal Abuse, or Fetal Alcohol Syndrome Disorder (FASD)

Georgia State Seal

Georgia Division of Family and Children Services
Child Welfare Policy Manual

Chapter:

(3) Intake

Policy Title:

Intakes Involving Substance Use or Abuse, Prenatal Abuse, or Fetal Alcohol Syndrome Disorder (FASD)

Policy Number:

3.4

Previous Policy Number(s):

3.7

Effective Date:

June 2023

Manual Transmittal:

2023-04

Codes/References

O.C.G.A. § 15-11-2 Definitions
O.C.G.A. § 16-13-21 Definitions
O.C.G.A. § 19-7-5 Reporting of Child Abuse
Child Abuse and Prevention Treatment Act (CAPTA)
Public Law 114-198 Comprehensive Addiction and Recovery Act of 2016

Requirements

The Division of Family and Children Services (DFCS) will:

  1. Receive intake reports of alleged child abuse involving substance use or abuse, when the following criteria is met:

    1. The caregiver’s current substance and/or alcohol use or abuse impacts their ability to meet the child’s needs; or

    2. Prenatal Abuse: Infants who are exposed to chronic or severe use of alcohol or the unlawful use of any controlled substance which results in:

      1. Symptoms of withdrawal in a newborn; or

      2. The presence of a controlled substance or a metabolite thereof in a newborn’s body, blood, urine or meconium that is not the result of medical treatment; or

        An individual’s receipt of medication for a substance use disorder taken under the supervision of a licensed healthcare professional is not the illegal use of drugs.

      3. Medically diagnosed and harmful effects in a newborn’s physical appearance or functioning.

        This includes Infants born with a fetal alcohol spectrum disorder (FASD).

  2. Complete the Intake Assessment gathering process with the reporter as outlined in policy 3.1 Intake: Receiving Intake Reports.

  3. Thoroughly evaluate the Intake Assessment to make an intake decision in accordance with policy 3.2 Intake: Making an Intake Decision.

Intakes involving prenatal exposure with no allegation of child abuse shall be assessed and processed as a Special Circumstance in accordance with policy 3.18 Intake: Special Circumstance Intakes Involving Prenatal Exposure (No Maltreatment).

Procedures

Centralized Intake Specialist

  1. Complete the Intake Assessment information gathering process with the reporter as outlined in policy 3.1 Intake: Receiving Intake Reports. In addition, gather the following information:

    Prenatal Abuse

    1. Type of substance used, the frequency of use, date/incident of last use, and if the mother is currently using.

    2. Whether the drug was prescribed or administer to the mother during labor and delivery.

    3. Medical reports/test results, including the level of the substance in the mother’s and/or child’s blood or urine. Is the level within normal limits of prescribed use?

    4. Did the mother self-disclose at the birth of the infant a substance or alcohol use problem and/or use during pregnancy?

    5. Behavioral description of withdrawal symptoms the infant is experiencing related to prenatal drug exposure or indications of FASD.

    6. A description of any facial abnormalities, growth deficiencies, skeletal deformities, organ deformities, or central nervous system handicaps that may accompany a diagnosis of FASD.

    Substance Use/Abuse

    1. Type of substance used, the frequency of use, date/incident of last use, and if the caregiver is currently using.

    2. What is the caregiver’s plan to address the substance use, abuse or addiction including plans to ensure the child’s well-being? Is there a relapse plan in place?

    3. Has the caregiver ever experienced black outs?

    4. Is the caregiver currently intoxicated and unable to perform basic parental duties?

    5. Are the children present when the caregiver is using substances? Are the victim children aware of the substance abuse/use?

    6. Are there drugs in the home? If so, where are they located and do the children have access to the drugs?

    7. How the caregiver’s use, abuse, or addiction impacts their ability to protect the child and to ensure their well-being needs.

    8. Does the caregiver make impulsive decisions that place the children in unsafe situations due to substance abuse addiction?

    9. How well are the children supervised? Are they left alone for extended period?

  2. Input the Intake Assessment into Georgia SHINES.

    1. Indicate the case involves substance abuse and/or prenatal drug exposure on the Person and Allegation Detail Page.

    2. Document the justification to support the case assignment recommendation.

  3. Thoroughly evaluate all information gathered to make an intake decision in accordance with policy 3.2 Intake: Making an Intake Decision.

Centralized Intake Specialist Supervisor

  1. Verify the information was gathered from the reporter in accordance with policy 3.1 Intake: Receiving Intake Reports, including gathering specific information on substance abuse and/or prenatal abuse.

  2. Thoroughly evaluate all information gathered and make an intake approval decision in accordance with policy 3.2 Intake: Making an Intake Decision.

Practice Guidance

Caregiver Substance and/or Alcohol Use or Abuse

Substance use or abuse may lead to multiple challenges for parents and their children. It can negatively affect the ways in which parents interact with and care for their children, which can increase the risk of maltreatment. Parental substance use or abuse may lead to difficulty with emotion regulation and decreased parental involvement and supervision. These negative parenting behaviors also place children at risk for medical and behavioral issues, serious injuries, and educational problems. For children in foster care, the parent’s use of illicit drugs has a significant negative impact on the length of time to permanency.

Prenatal Abuse

The Child Abuse Prevention and Treatment Act (CAPTA) includes provisions to address infants prenatally exposed to substances, requiring states to implement a Plan of Safe Care to address the infant’s well-being needs once identified as affected. In 2016, the Comprehensive Addiction and Recovery Act (CARA) was signed into law reframing how states deal with prenatal exposure to substances. CARA requires infants exposed to any type of drug (legal or illegal) are assessed and provided services through a Plan of Safe Care.

Affected

An infant “affected” by prenatal exposure to substance use means:

  1. The infant is experiencing symptoms of withdrawal, or exhibiting harmful effects in his/her physical appearance or functioning due to exposure to substances (legal or illegal); or

  2. The infant has tested positive for the presence of a substance or a metabolite thereof in his/her body, blood, urine or meconium; or

  3. The infant has symptoms of a Fetal Alcohol Spectrum Disorder; or

  4. The mother testing positive for illegal substances at the birth of the infant; or

  5. The mother testing positive for prescription drugs due to misuse at the birth of the infant; or

  6. The mother self-disclosed at the birth of the infant a substance or alcohol use problem and use during pregnancy.

Controlled Substance

A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by a government (federal or state law). This may include illegal drugs and prescription medications.

Current Use of Drugs

Current drug use means the illegal use of drugs occurred recently enough to justify a reasonable belief that a person’s drug use is current. Examples of current use include a positive drug screen or a newborn exhibiting withdrawal symptoms from the unlawful use of a controlled substance.

Fetal Alcohol Syndrome Disorder (FASD)

FASD diagnostic conditions include:

  • Type I: Fetal Alcohol Syndrome with confirmed maternal exposure.

  • Type II: FAS without confirmed maternal exposure.

  • Type III: Alcohol-related birth defects (ARBD).

  • Type IV: Alcohol-related neurodevelopmental disorder (ARND).

Symptoms of FASD can include facial abnormalities, growth deficiencies, skeletal deformities, organ deformities, central nervous system handicaps, and behavioral problems. These symptoms can have lifelong implications for children who were exposed to alcohol in the womb; however, some children with FASD who receive special education and adequate social services are more likely to reach their developmental and educational potential than those who do not receive those services.

Forms and Tools

N/A