19.25 Drug Screens

Georgia State Seal

Georgia Division of Family and Children Services
Child Welfare Policy Manual

Chapter:

19 Case Management

Policy Title:

Drug Screens

Policy Number:

19.25

Previous Policy Number(s):

N/A

Effective Date:

June 2023

Manual Transmittal:

2023-04

Codes/References

O.C.G.A. § 15-11-212
42 CFR § 8.12(f)
Public Law 105-89 Adoption and Safe Families Act of 1997

Requirements

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

  1. Use drug screens as one component of a comprehensive family assessment to:

    1. Evaluate family functioning (see policy 19.13 Case Management: Family Functioning Assessment).

    2. Motivate parents/guardians/legal custodians to engage in treatment.

    3. Evaluate the progress of parents/guardians/legal custodians during the early stages of recovery.

    4. Support the progress of parents/guardians/legal custodians in treatment and recovery.

  2. Conduct drug screens to support case assessment, case planning, assessing progress in treatment and recovery, and/or legal requirements when:

    1. Substance or alcohol use by a caregiver or other adult household member is alleged as a contributing factor to child maltreatment.

    2. Substance or alcohol use by a caregiver or other adult household member is assessed to be a contributing factor to child maltreatment. This includes a disclosure by a caregiver that substance or alcohol use is a concern or impacts their ability to care for their child.

    3. The court orders the drug screens or drug screens are part of the court approved case plan.

  3. Use drug screens as part of the evaluation process for prospective caregivers:

    1. Conduct drug screens when:

      1. Evaluating the prospective primary and secondary kinship caregiver (relative or fictive kin), prior to approval of the Kinship Assessment for the placement of a child in foster care.

      2. Evaluating the prospective primary and secondary foster or adoptive caregivers (including kinship).

        The drug screening must be conducted within 12 months prior to the approval of the Initial Family Evaluation.

      3. Evaluating prospective adoptive families including their adult household members (18 years and older) prior to the placement of a child for an independent adoption by a third party.

      4. There is reasonable suspicion of illegal drug use or prescription drug abuse by the primary and secondary foster, adoptive and kinship caregivers.

    2. Disqualify prospective caregivers who decline to consent to a drug screen.

    3. Disqualify prospective caregivers with positive drug screens for any illegal drug. If the drug screen is positive for prescribed medication, the prescribing physician must provide a statement that prescribed medication would cause a drug screen result to be positive for the substance indicated on the screen; and the levels indicated on the drug screen result is in accordance with administering the medication as prescribed.

  4. Request parents/guardians/legal custodians in active cases to complete a minimum of two random drug screens per month to provide evidence of success, monitor recovery goals and evaluate progress in treatment.

    Drug screens can be obtained through coordination with Family Treatment Courts (FTC), Department of Community Supervision (DCS), Department of Behavioral Health and Developmental Disabilities (DBHDD), other government entities, medical facilities, healthcare providers or substance use treatment facilities/providers. Obtain written informed consent via a valid Authorization for Release of Information.

  5. Determine the drug screen panel type based on the individual circumstance.

  6. Ensure drug screens:

    1. Are conducted and signed by a qualified professional.

    2. Include confirmation testing for positive results.

  7. Adhere to provisions regarding the disclosure of drug screen results (protected health information) as outlined in policy 2.5 Information Management: Health Insurance Portability and Accountability Act, and any other confidentiality requirements outlined in policy 2.6 Information Management: Confidentiality and Safeguarding Information.

Procedures

Drug Screens in Active Cases

The Social Services Case Manager (SSCM) will:

  1. Consult with the Social Services Supervisor (SSS) to:

    1. Discuss how the drug screen fits into the overall case assessment, case planning or for court related requirements (see policy 19.24 Case Management: Family Treatment Court).

    2. Determine the drug screen method based on the case circumstances, i.e., hair follicle, urinalysis, breath (see the Forms and Tools: Pros and Cons of Different Specimen Sources).

    3. Determine the type of drug screen panel based on case circumstances, allegations, and purpose.

    4. Identify the most appropriate vendor or facility to perform the drug screen.

    Whenever possible, appropriate and with a valid Authorization for Release of Information, the results of random drug screens should be requested and/or shared across systems (i.e. Family Treatment Court, Department of Behavioral Health and Developmental Disabilities, Department of Community Supervision, Department of Public Health, other government entities, medical facilities, healthcare providers or substance use treatment facilities/providers, etc.) to avoid duplication of services while promoting a more integrated and effective approach to recovery services for the parent/guardian/legal custodian or other household members.

  2. Complete and obtain supervisory approval for the service authorizations in Georgia SHINES when using DFCS contracted drug screen providers.

    Prevention of Unnecessary Placement (PUP) funds may be authorized to pay for drug screens when no other payment sources are identified i.e., private health insurance, Medicaid etc. (see policy 18.3 Support Services to Preserve or Reunify Families: Prevention of Unnecessary Placement (PUP)).

  3. Engage the parent/guardian/legal custodian or other individual to build consensus regarding the need for a drug screen:

    1. Explain the purpose of the drug screen including case assessment, case planning, assessing progress in treatment and recovery, and/or ordered by the court.

    2. Inform him/her of the behavioral and environmental indicators that support the drug screen request (see Practice Guidance: Observing and Documenting Behavioral and Environmental Indicators of Substance Abuse in policy 19.26 Case Management: Case Management Involving Substance Abuse or Use).

    3. Provide full disclosure regarding drug screens (see Practice Guidance: Full Disclosure / Informed Consent), including:

      1. Drug screens are only one part of a comprehensive family assessment;

      2. Drug screens are voluntary unless ordered by the court;

        Drug screens ordered by the court or included in a court approved case plan are not considered voluntary.

      3. They have the right to refuse the drug screen;

      4. The implications of not submitting to the drug screen; and

      5. The benefits of the drug screen in supporting their treatment and recovery.

    4. Explore what the drug screen is likely to reveal to allow the opportunity for self-disclosure and engage in the discussion around further assessment and/or treatment, as applicable.

    5. Gather information about any prescription medication and over the counter drug use.

    6. Provide information about the drug screen procedures (i.e. vendor, location, date, time, method, etc.).

    7. Obtain the individual’s signature on:

      1. The drug and/or alcohol screen referral form, if applicable.

      2. The Authorization for Release of Information form to obtain the results of the drug screen and to share with other agencies working in partnership with the caregiver and DFCS, as applicable.

    8. If consensus cannot be reached regarding the need for and benefits of the drug screen:

      1. Explore the reason for declining the drug screens.

      2. Explore any fears and anxiety regarding the drug screen. (i.e., fear of the child being removed, etc.)

      3. Consult with the Social Services Supervisor (SSS) regarding the impact on case assessment, case planning, assessing progress in treatment and recovery, and/or legal requirements.

  4. Obtain a copy of the drug screen results from the provider/facility.

    1. Review the results of the drug screen with the SSS and discuss how the results of the drug screen fits within the comprehensive family assessment, case planning and/or court ordered requirements.

    2. Review the results of the drug screen with the parent/guardian/legal custodian or other individual tested within 48 hours of receipt and discuss how the results impact the comprehensive family assessment, case planning and/or court ordered requirements.

      To maintain partnership and open communication with caregivers or other individuals screened, avoid using judgmental terms such as “clean” or “dirty” when discussing the results of the drug screen. The professional and appropriate terminology is “positive” or “negative”.

    3. If the drug screen is positive:

      1. Provide an opportunity for the parent/guardian/legal custodian or other individual to explain the results.

        Individuals in Medication Assisted Treatment (MAT) programs will have positive drug screens for the medications used to treat the alcohol or substance use disorder (see Practice Guidance: Commonly Used Medication for Medication Assisted Treatment).

      2. Use consensus building techniques to encourage the parent/guardian/legal custodian or other individual to continue working on their individual level outcomes (ILO) as part of the action plan.

      3. If not reached previously, build consensus regarding the opportunity for intervention; or the need to update the treatment plan if the caregiver is already receiving treatment.

      4. Consult with the substance abuse treatment provider to review the relapse prevention plan to reassess the array of services and interventions for parents/caregivers or other individuals currently in treatment.

        It is important to determine if the positive drug screen and other behavioral indicators represent a lapse or a relapse to ensure the appropriate modification to the relapse prevention plan (see Practice Guidance: Lapse vs. Relapse).

      5. Consider a modification of the frequency of the drug screens.

      6. Assess the need for an alcohol and/or drug assessment for parent’s/caregiver’s not receiving treatment in accordance with policy 19.26 Case Management: Case Management Involving Substance Abuse or Use.

    4. If the drug screen is negative:

      1. Acknowledge and celebrate the parent’s/guardian’s/legal custodian’s or other individual’s accomplishment when the negative screen and other indicators support behavioral changes.

      2. Offer continued support and encouragement for their continued work on their individual level outcomes (ILO) as part of the action plan.

  5. Provide notification to the court when drug screens are court ordered or are part of a court approved case plan.

  6. Document all activities in Georgia SHINES within 72 hours of occurrence, including the discussion with the parent/guardian/legal custodian and/or other individuals regarding the need for the drug screen, his or her decision, and the results of each drug screen. Upload a copy of the drug screen results and any other relevant forms (referral, ROI, etc.) into Georgia SHINES External Documentation.

The Social Services Supervisor (SSS) will:

  1. Discuss with the SSCM how the drug screen fits within the comprehensive family assessment, case planning, etc.

  2. Conduct a supervisor staffing with the SSCM to:

    1. Determine the drug screen method base on the case circumstance, i.e. urinalysis, hair follicle, breath (see the Forms and Tools: Pros and Cons of Different Specimen Sources).

    2. Determine the type of drug screen panel based on circumstances, allegations and purpose.

  3. Assist the SSCM in identifying the most appropriate vendor or facility to perform the drug screen.

  4. Approve service authorizations in Georgia SHINES prior to referring the parent/guardian/legal custodian or other individual for a drug screen for DFCS contracted drug screen providers.

  5. Provide guidance to the SSCM to determine next steps when consensus cannot be reached regarding the need for drug screens.

  6. Discuss the results of the drug screen and how next steps for case management interventions based on the overall assessment.

  7. Ensure that the SSCM has document all activities into Georgia SHINES within 72 hours of occurrence.

Drug Screens for Prospective Caregivers (Foster, Adoptive, Kinship)

The SSCM will:

  1. Consult with the SSS to:

    1. Ensure that all primary and secondary prospective caregivers undergo drug screening within the 12 consecutive months prior to final approval of the Initial Family Evaluation (IFE).

    2. Determine the type of drug screen panel and identify the most appropriate vendor or facility to perform the drug screen.

    At a minimum, prospective caregivers are to be screened for marijuana/cannabinoids (THC), cocaine, amphetamines/methamphetamines, opiates, ecstasy, and phencyclidine (PCP). The drug screen must be conducted and signed by a qualified health professional or laboratory.

  2. Engage the prospective caregiver regarding the purpose and process of the drug screen:

    1. Discuss with him/her that the drug screen is needed as a part of the caregiver evaluation process to support approval decision-making related to the care and/or placement of a child.

    2. Provide information about the drug screen procedure (i.e. vendor, location, date, time, method, etc.).

    3. Explore and document prescribed and over-the-counter medications.

    4. Obtain the individual’s signature on:

      1. The drug and/or alcohol screen referral form, if applicable.

      2. The Authorization for Release of Information form to obtain the results of the

      3. drug screen and to share with other agencies working in partnership with the caregiver and DFCS, as applicable. Obtain a copy of the drug screen results from the provider/facility.

  3. Consult with the SSS regarding the drug screen results and how it fits within the evaluation of the prospective caregiver.

    1. Disqualify prospective caregivers who decline to consent to a drug screen, this includes any household member required to submit to drug screen as part of the evaluation.

    2. Disqualify prospective caregivers with positive drug screens for any illegal drug or misuse or abuse of legal drugs.

    3. If the drug screen is positive for legal drug (medication), the healthcare provider must provide a statement indicating:

      1. The healthcare provider has prescribed medication to the prospective caregiver that would result in a positive screen for the substance indicated on the drug screen results; and

      2. The levels indicated on the drug screen result is in accordance with administering the medication as prescribed.

  4. Document all activities in Georgia SHINES within 72 hours of occurrence, including the discussion with the caregiver or their household member regarding the need for the drug screen, his/her decision, and the results of each drug screen. Upload a copy of the drug screen results and any other relevant forms (referral, ROI, etc.) into Georgia SHINES External Documentation.

Practice Guidance

Drug Screens

Drug screening refers to the use of various biologic sources, such as urine, saliva, sweat, hair, breath, blood, and meconium to determine the presence of specific substances or their metabolites in an individual’s system. Timing is a crucial factor in drug and alcohol screening. The amount of time a drug remains in the body is dependent on a variety of factors including the amount of drug taken and the metabolism of the individual. A negative drug screen result does not always mean there are no drugs present in the person being tested, it means there are not drugs present in the sample tested above the cut off limit. There is no form of screening that can absolutely guarantee that an individual is not using drugs. A provider or facility’s drug screening procedures should differentiate between legitimate therapeutic drug use and illegal drug use or misuse. The screens should rule out legal medications that individuals use for legitimate medical reasons before declaring a drug screen result to be positive. A Medical Review Officer (a licensed physician who reviews and interprets lab results) can assist with interpreting the results.[1] For a list of commonly abused drugs and their effects see Forms and Tools: Commonly Abused Drugs & Their Effects.

Covered entities [under federal disability rights laws] are not prohibited from drug testing designed to ensure that a person who formerly engaged in the illegal use of drugs is no longer currently engaged in the illegal use of drugs. In other words, federal disability rights laws do not prohibit a covered entity from conducting drug testing.[2]

Using Drugs Screens in Case Assessment and Case Planning

Social Services Case Managers have the opportunity to collect relevant information about family functioning, make informed decisions, and take timely and appropriate action to safeguard children, when a caregiver is unable to do so. Drug and alcohol use may impair a parent/guardian/legal custodian’s judgment and therefore interfere with their ability to provide proper care and control of their child. Drug screens should not be approached with a focus on trying to “catch” a parent/guardian/legal custodian using drugs or alcohol. Rather, it should be used as part of the comprehensive assessment process to help the parent/guardian/legal custodian identify whether he/she is developing or has an alcohol or substance use problem, and whether they need treatment or how are progressing in treatment. This approach will encourage parents/caregivers to be honest about their substance or alcohol use including lapses or relapses in their recovery and seek assistance. Further, the use of the drug screen may help staff to identify the condition(s) that may be impacting the caregiver’s parental functioning. However, drug screens alone do not provide sufficient information for making decisions about the disposition of a case (i.e. substantiating allegations of child abuse or neglect, child removal, family reunification or termination of parental rights).

When determining whether a child is in present or impending danger due to the parent’s/guardian’s/legal custodian’s substance abuse it is important to use a combination of screening and assessment processes that include a family functioning assessment, collaboration with substance abuse treatment providers and medical professionals, clinical instruments, random drug screens, self-reports, and observations of behavioral indicators[3] (see policy 19.26 Case Management: Case Management Involving Substance Abuse or Use).

Appropriate Uses for Drug and Alcohol Screens[4] include:

  1. As one component of a case assessment when there are indicators that substance and alcohol use is a contributing factor to maltreatment;

  2. To assist a parent/guardian/legal custodian in their readiness for treatment interventions;

  3. When substance and alcohol use is a contributing factor in maltreatment and the parent is not participating in a substance abuse treatment program;

  4. To provide positive reinforcement and to monitor parents, particularly in early recovery.

Obtaining Drug Screens for Parents/Caregivers in Treatment

When a parent/guardian/legal custodian is actively participating in a substance or alcohol treatment program and in compliance with their treatment plan that includes random drug screening, the SSCM should coordinate with the substance or alcohol treatment provider to obtain the drug screen results.

Lapse vs. Relapse

There is a difference between having one slip and having a relapse.[5] A lapse represents a temporary slip or return to a previous behavior that one is trying to control or quit (usually a onetime occurrence). A relapse represents a full-blown return to a pattern of behavior that one has been trying to moderate or quit altogether. The SSCM should assess the positive drug screen along with other indicators (such as a change in behavior or appearance, missed appointments, failure to through, etc.) to determine the potential impact on the child’s safety (see policy 19.26 Case Management: Case Management Involving Substance Abuse or Use).

The SSCM has the responsibility to disclose all significant information[6] about drug screens to parents/caregivers including the implications of completing drug screens such as the drug screen may be presented as evidence if legal action is necessary. Also, the SSCM should explain the benefits of completing drug screens such as to assist with evaluating their physical, psychological and social well-being and evaluating progress in substance abuse treatment and recovery. When requesting a drug screen, avoid using statements that can be perceived as coercive or punitive. Statements to avoid include: “If you don’t agree to testing, I’ll have no choice but to remove your children”, or “I’ll limit your visitation with your children”.

Unless drug screens are mandated by court order or other legal requirements, individuals have the right to choose whether to participate in the drug screens. Three conditions must be met before a decision can be considered fully informed:

  1. Capacity: The individual can make rational decisions.

  2. Comprehension: Information must be provided in a way that the individual understands, including language and words the individual understands. The individual should be asked to repeat her/his understanding of the information, so it is assured things were fully understood and fill in whatever gaps exist.

  3. Voluntariness: Implies that the individual is free to make this choice and is acting without any coercion.

Drug Screen Panel Types

Drug Screen Panel Types[7]
Tetrahydrocannabinol (THC) Cocaine Opiates Phencyclidine (PCP) Amphetamines Benzodiazepines Barbiturates Methadone Propoxyphene Ethyl Glucuronide (EtG) Oxycodone 3,4-methylenedioxyamphetamine (MDA)

6 Panel

(Oral Fluid)

ü

ü

ü

ü

ü

ü

7 Panel

(Urine)

ü

ü

ü

ü

ü

ü

ü

7 Panel

(Hair)

ü

ü

ü

ü

ü

ü

ü

12 Panel

(Urine)

ü

ü

ü

ü

ü

ü

ü

ü

ü

ü

ü

ü

Urine Synthetic Cannabinoids – A urine panel comprised of over 40 synthetic cannabinoid metabolites, including substances such as Spice, K2, etc. (must be court ordered)

Urine Synthetic Stimulants – A urine panel comprised of over 60 synthetic stimulant metabolites, including substances such as Bath Salts, Flakka, etc. (must be court ordered)

Urine Kratom – A urine panel comprised of Mitragynine and 7 Hydroxymitragynine (must be court ordered)

NOTES

  • Always verify with the vendor or facility the substances included in the drug panel.

  • THC mind-altering (psychoactive) commonly known as marijuana and cannabis.

  • Cocaine is a euphoria-producing stimulant drug. Commonly known as Coca, Coke, Crack, Flake and Snow.

  • Opiates is a narcotic, commonly known as Heroin, Big H, Black Tar, Chiva, Hell Dust, Horse, Negra and Smack.

  • Phencyclidine (PCP) is a mind-altering drug. PCP is in a class of drugs called hallucinogens (substances that cause hallucinations).

  • Amphetamines are stimulants and many are legally prescribed and used to treat attention-deficit hyperactivity disorder (ADHD). Commonly known as crank, ice, speed, uppers, meth, bennies, black beauties.

  • Benzodiazepines are psychoactive drugs used to treat panic attacks, generalized anxiety, seizures, and alcohol withdrawal. Commonly known as Valium, Xanax

  • Barbiturates are a sedative-hypnotic drug, used to decrease anxiety and fight insomnia. Known commonly as ‘downers’.

  • Methadone can be abused as a pain reliever and can cause extreme exhaustion and numbness.

  • Propoxyphene, also known as Darvon, is a narcotic pain reliever and is highly addictive.

  • EtG test is used to detect the presence of ethyl glucuronide, breakdown of ethanol (alcohol).

  • MDA acts as both a stimulant and psychedelic commonly used by adolescents and young adults. Commonly known as Sally, Sass. MDA is the parent drug of MDMA (commonly known as E, Ecstasy, X, Molly).

Urine Toxicology Detection Periods for Different Substances

Most substances of abuse can be detected for approximately 2 to 4 days, the higher the dose taken and the more frequently the substance has been used over an extended time, the more likely that it will be detected.[8] Although substances are excreted at various rates, they accumulate in the body with continued use. Whereas a single use of cocaine may be detectable in urine for only a day or less, continued daily use is likely to be detectable for 2 to 3 days following its discontinuation. Chronic use of such drugs as marijuana, PCP, and benzodiazepines may be detectable for up to 30 days, whereas alcohol remains in the system for 24 hours or less. Realistically, it may be difficult to detect illicit substances in most clients who stop all use for several days before a drug screen. An accurate profile of a client’s substance use over more than a few days requires both urine test results and a good retrospective history.

Substance Typical Urine Detection Period

Amphetamine or methamphetamine

2–4 days

Barbiturates

Short-acting—Secobarbital

1–2 days

Long-acting—Pentobarbital

2–4 days

Phenobarbital

10–20 days

Benzodiazepines

Therapeutic dose

3–7 days

Chronic dosing

Up to 30 days

Cocaine

1–3 days

Cannabinoids/THC

Casual use

1–3 days

Daily use

5–10 days

Chronic use

Up to 30 days

Ethanol (alcohol)

12–24 hours

Opioids (e.g., codeine, morphine)

1–3 days

Methadone

2–4 days

Propoxyphene

6–48 hours

MDMA

1–5 days

PCP

Acute use

2–7 days

Chronic use

Up to 30 days

Commonly Used Medication for Medication Assisted Treatment

MAT[9] encompasses treatment for drug and alcohol addiction with other medications and psychotherapies.

Medications for Alcohol Dependence Medications for Opioid Dependence

  1. Naltrexone: (ReVia®, Vivitrol®, Depade®)

  2. Disulfiram: (Antabuse®)

  3. Acamprosate: (Campral®)

  1. Methadone: Methadose®, Dolophine®[10]

  2. Buprenorphine: (Suboxone® and Subutex®)

  3. Naltrexone: (ReVia®, Vivitrol®, Depade®)

10. Drug Enforcement Administration Office of Diversion Control Drug & Chemical Evaluation Section (2014 March). Methadone. Available from www.deadiversion.usdoj.gov/drug_chem_info/methadone/methadone.pdf

Forms and Tools

Commonly Abused Drugs
Common Drug Testing Topics
Know Your Rights: Rights for Individuals on Medication-Assisted Treatment
Pros and Cons of Different Specimen Sources
The Effects of Substance of Abuse on Behavior and Parenting

1. Center for Substance Abuse Treatment. Drug Screening in Child Welfare: Practice and Policy Considerations. HHS Pub. No. (SMA) 10-4556 Rockville, MD: Substance Abuse and Mental Health Services Administration, 2010. Retrieved from ncsacw.acf.hhs.gov/topics/drug-testing/policy-and-practice-considerations-for-drug-testing-in-child-welfare
2. Office for Civil Rights. Department of Health and Human Services. (n.d.). Part 2 Civil Rights Protections for Individuals with an Opioid Use Disorder [Video]. YouTube. youtu.be/7Me9cEjf8jo
3. Ibid
4. Drug Screening Practice Guidelines: Iowa Bench Card. ncsacw.acf.hhs.gov/files/IA_Drug_Testing_Bench_Card_508.pdf
5. Recovery.org. The Truth About Relapse: 5 Misconceptions Explained. www.recovery.org/pro/articles/the-truth-about-relapse-5-misconceptions-explained
6. Adapted from Brian Simmons, MSW, PhEd., Child Welfare Ethics and Values 2003, California Social Work Education Center (CalSWEC) University of California, Berkeley. Retrieved from calswec.berkeley.edu/files/uploads/pdf/CalSWEC/Participant_Ethics_Values.pdf
7. AverHealth
8. www.ncbi.nlm.nih.gov/books/NBK64092
9. Attorneys at the Legal Action Center authored, Know Your Rights: Rights for Individuals on Medication Assisted Treatment. HHS Publication No. (SMA) 09-4449. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2009.