3.18 Special Circumstance Intakes Involving Prenatal Exposure (No Maltreatment)

Georgia State Seal

Georgia Division of Family and Children Services
Child Welfare Policy Manual

Chapter:

(3) Intake

Policy Title:

Special Circumstance Intakes Involving Prenatal Exposure (No Maltreatment)

Policy Number:

3.18

Previous Policy Number(s):

3.7

Effective Date:

June 2023

Manual Transmittal:

2023-04

Codes/References

O.C.G.A. §15-11-2 Definition
O.C.G.A. §16-13-21 Controlled Substance
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 from healthcare providers involving infants prenatally exposed when the following criteria is met:

    1. A newborn is affected by or displaying symptoms of withdrawal from the lawful use of any controlled substance as a result of medical treatment (including medication for a substance abuse disorder); and

    2. The information is assessed to not include allegations of child abuse.

  2. Gather from the reporting healthcare professional the circumstances surrounding the prenatal exposure.

  3. Screen-in Intake Assessments that meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

  4. Screen-out Intake Assessments when the information gathered does not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    Intake Assessments that do not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment) shall be processed and assessed in accordance with policies 3.1 Intake: Receiving Intake Reports and 3.2 Intake: Making an Intake Decision.

  5. Notify the County Division of any assigned Special Circumstance Prenatal Exposure (No Maltreatment).

Intake Assessments with alleged substance use or abuse and/or prenatal abuse shall be assessed in accordance with policy 3.4 Intake: Intakes Involving Substance Use or Abuse, Prenatal Abuse or Fetal Alcohol Syndrome Disorder.

Procedures

Centralized Intake Specialist

  1. Gather and document information from the reporter regarding the prenatal exposure:

    1. Obtain the name, address, date of birth, demographics, and current location of all children.

    2. Obtain the name, address, date of birth, demographics, and current location of all parents (mother(s) and father(s)) and legal guardians, regardless of where the child(ren) reside.

    3. If the child and/or parent have or is believed to have, American Indian heritage (see policy 1.6 Administration: Indian Child Welfare Act (ICWA) and Transfer of Responsibility for Placement and Care to a Tribal Agency).

    4. Medical diagnoses of the mother, the type of medication used, frequency of use, and whether the mother is currently using the controlled substance.

    5. Whether the drug was prescribed or administered to the mother during labor and delivery.

    6. Medical reports/test results. 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?

    7. Is there information that the mother is misusing prescribed medication, i.e., doctor shopping, higher levels than prescribed, etc.

    8. Behavioral description of withdrawal symptoms the infant may be experiencing related to prenatal exposure to substances.

    9. Whether the mother is functioning appropriately despite using substances.

    10. Inform the reporter of the next steps in the intake process.

  2. Conduct safety screenings in accordance with policy 19.9 Case Management: Safety Screenings.

  3. Thoroughly evaluate all information gathered:

    1. Determine if the Intake Assessments meets the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    2. Analyze DFCS history in accordance with policy 19.10 Case Management: Analyzing DFCS History.

    3. Evaluate for indicators of child maltreatment and safety issues.

  4. Input the Intake Assessment into Georgia SHINES.

    1. Classify as a Special Circumstance Prenatal Exposure (No Maltreatment).

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

  5. Recommend the Intake Assessment is:

    1. Screened-in when the information gathered meets the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    2. Screened-out when the information gathered does not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    Intake Assessments that do not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment) must be processed and assessed in accordance with policies 3.1 Intake: Receiving Intake Reports and 3.2 Intake: Making an Intake Decision.

  6. Participate in a supervisory staffing to discuss the intake disposition. Be prepared to discuss how the information gathered meets or does not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

  7. Notify the County Division’s CPS Intake Communication Center (CICC) Point of Contacts (POC) of any assigned Special Circumstance Prenatal Exposure (No Maltreatment).

  8. Submit the Intake Assessment to the Centralized Intake Specialist Supervisor for approval.

Centralized Intake Specialist Supervisor

  1. Thoroughly evaluate all information gathered and review the Intake Assessment in Georgia SHINES.

    1. Determine if the circumstances meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    2. Verify the Intake Assessment is classified as a Special Circumstance Prenatal Exposure (No Maltreatment).

    3. Document a justification to support the case assignment decision.

  2. Staff the Intake Assessment with the Centralized Intake Specialist in accordance with policy 19.6 Case Management: Supervisor Staffing.

  3. Screen-in the Intake Assessment when the information gathered meets the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    1. Stage progress the Intake Assessment to a Special Circumstance.

    2. Assign the Special Circumstance to the County Division’s CICC POC.

  4. Screen-out the Intake Assessment when the information gathered does not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment).

    Intake Assessments that do not meet the criteria for a Special Circumstance Prenatal Exposure (No Maltreatment) must be processed and assessed in accordance with policies 3.1 Intake: Receiving Intake Reports and 3.2 Intake: Making an Intake Decision.

Practice Guidance

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 also signed into law and reframed how states are required to deal with prenatal exposure to substances, ensuring infants exposed to any type of drug, legally prescribed or used illegally, are assessed and provided services through a Plan of Safe Care.

Intakes involving prenatal exposure (no maltreatment) deals exclusively with infants’ prenatal exposure to substances that were legally prescribed and used as prescribed by the mother during pregnancy. Intake reports involving prenatal exposure (no maltreatment) do not contain allegations of prenatal abuse or child abuse.

Examples of Intakes Reports that Should be Assigned Special Circumstance Prenatal Exposure (No Maltreatment)

  1. The infant is prenatally exposed resulting from the mother’s use of prescribed medication for an illness. The mother is following her medication and treatment plan, as verified by her healthcare provider.

  2. The infant is prenatally exposed resulting from the mother being given prescribed medication during the delivery process.

  3. The infant is prenatally exposed due to the mother’s participation in a Medication Assisted Treatment (MAT) program for a substance use disorder. The mother is in compliance with her medication and treatment plan, as verified by the substance treatment provider and her healthcare provider.

Examples of Intake Reports that Should Not be Assigned as Special Circumstance Prenatal Exposure (No Maltreatment)

  1. The mother tested positive for an illegal substance (including marijuana) at the birth. The intake assessment should be assessed using policy 3.4 Intake: Intakes Involving Substance Use or Abuse, Prenatal Abuse or Fetal Alcohol Syndrome Disorder.

  2. The mother tested positive for an illegal substance at the birth, but the infant tested negative for the presence of a substance or a metabolite thereof in his/her body, blood, urine or meconium. The intake assessment should be assessed using policy 3.4 Intake: Intakes Involving Substance Use or Abuse, Prenatal Abuse or Fetal Alcohol Syndrome Disorder.

  3. The mother tested positive for an illegal substance during prenatal visits, but she tested negative at the birth. The infant’s meconium test result is pending. The intake assessment should be assessed using policy 3.4 Intake: Intakes Involving Substance Use or Abuse, Prenatal Abuse or Fetal Alcohol Syndrome Disorder.

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.

Forms and Tools

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