20.5 Infants Prenatally Exposed to Substances (No Maltreatment)

Georgia State Seal

Georgia Division of Family and Children Services
Child Welfare Policy Manual

Chapter:

(20) Special Circumstances

Policy Title:

Infants Prenatally Exposed to Substances (No Maltreatment)

Policy Number:

20.5

Previous Policy Number(s):

5.12

Effective Date:

November 2023

Manual Transmittal:

2023-03

Codes/References

O.C.G.A. § 15-11-2 Definitions
O.C.G.A. § 19-7-5 Reporting of Child Abuse
O.C.G.A. § 49-5-8 Powers and Duties of the Department
O.C.G.A. § 49-5-40 Definitions; Confidentiality of Records; Restricted Access to Records
O.C.G.A. § 49-5-41 Persons and Agencies Permitted to Access Records
Child Abuse Prevention and Treatment Act (CAPTA)
Public Law (PL) 104-191 Health Insurance Portability and Accountability Act (HIPAA) of 1996
PL 114-198 Comprehensive Addiction and Recovery Act (CARA) of 2016

Requirements

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

  1. Assess the health and developmental needs of infants identified as affected by prenatal substance exposure, and the health and substance use disorder treatment needs of parent(s) and their families.

    Special Circumstances Infants Prenatally Exposed to Substances (No Maltreatment) solely focuses on an infants’ prenatal exposure to substances that were legally prescribed and used as prescribed by the mother during pregnancy. These assessments do not include prenatal abuse (i.e., use of illegal substances during pregnancy) or have indicators of child abuse.

  2. Conduct face-to-face contact with the infant and mother within five weekdays of the receipt of the intake report to:

    1. Assess the health, developmental and substance use disorder needs of the infant and the mother; and

    2. Coordinate with the family, hospital, and others to plan for the infant’s discharge.

    If the infant has not discharged from the hospital, make efforts to conduct the visit at the hospital.

  3. Determine with the health care provider that the medication the mother was taking during pregnancy was as prescribed, and when applicable verify with the medication assisted treatment (MAT) provider that the mother is complying with her treatment plan.

  4. Assess and discuss safe sleep practices with the parent(s). Take action to remedy unsafe sleeping situations.

  5. Submit a referral to Babies Can’t Wait (BCW) via Children 1st for a developmental screening in accordance with policy 19.28 Case Management: Children 1st and Babies Can’t Wait.

  6. In partnership with other agencies providing services to the family, develop and implement a Plan of Safe Care for families with infants identified as being affected by prenatal exposure in accordance with policy.

  7. Adhere to Health Insurance Portability and Accountability Act and confidentiality provisions outlined in policies 2.5 Information Management: Health Insurance Portability and Accountability Act (HIPAA) and 2.6 Information Management: Confidentiality/Safeguarding Information.

  8. Complete the Special Circumstance Infants Prenatally Exposed to Substances (No Maltreatment) within 45 calendar days of the receipt of the intake report.

  9. Document case activities in Georgia SHINES within 72 hours of the occurrence.

  10. Immediately report any new, known, or suspected instances of child abuse to the CPS Intake Communications Center (CICC) as outlined in policy 3.24 Intake: Mandated Reporters.

Procedures

Social Services Case Manager

  1. Review the intake assessment and confirm the reported information meets the criteria for Infants Prenatally Exposed to Substances (No Maltreatment).

  2. Participate in a supervisor staffing:

    1. Discuss whether the information reported meets the criteria for Special Circumstance Infants Prenatally Exposed to Substances (No Maltreatment); and

      Assigned Special Circumstances Infants Prenatally Exposed to Substances (No Maltreatment) that do not meet the criteria for Infants Prenatally Exposed to Substances (No Maltreatment) must be referred back to the CPS Intake Communication Center (CICC) to processed and assessed as a child abuse report.

    2. Discuss how to engage the family and initiate the development of the Plan of Safe Care.

  3. Arrange for language assistance (interpreter and/or translation services) for individuals identified as limited English proficient (LEP) and auxiliary aids for sensory impaired individuals in accordance with policy 1.4 Administration: Non-Discriminatory Child Welfare Practices.

  4. Conduct a face-to-face contact with the infant and mother within five weekdays of the intake report:

    1. Explain the assessment process, including:

      1. Supporting the family in developing and implementing a plan of safe care for the infant, parent(s), and other family members.

      2. Linking the infant and family to services to address health and/or developmental needs of the infant, parent(s), and family;

      3. The process will take approximately 45 days; and

      4. Other agencies will continue to monitor services, as needed, after DFCS case closure.

    2. Explain DFCS’ obligation to maintain confidentiality and safeguard information to prevent unauthorized disclosure:

      1. Personal information provided during the assessment will be kept confidential (see policy 2.6 Information Management: Confidentiality/Safeguarding Information).

      2. DFCS cannot share protected health information (PHI) with any person, agency, or contractor without prior written authorization from the owner of the PHI, unless otherwise permitted by law. Provide a copy of the Notice of Privacy Practices and obtain signature(s). See policy 2.5 Information Management: Health Insurance Portability and Accountability Act (HIPAA).

      3. The type of information that will be maintained in the DFCS case record and of the information that can and cannot be released to the parent(s) upon request. Provide a copy of the Notice of Case Record Information Available to Parents/Guardians and obtain signatures (see policy 2.10 Information Management: J.J. v. Ledbetter Parent or Guardian Request for Information).

    3. Discuss the impact of the mother’s health condition on her ability to meet the needs of the infant and any other children. Determine whether the family already has a plan in place to support the mother in caring for the infant.

    4. Discuss the substance use needs of the mother.

    5. Determine if there are other children in the home and discuss any supports or services needed to meet their needs as applicable.

    6. Determine whether the parent(s) has selected a pediatrician or healthcare provider for the infant and request the date of the first health check; if the parent(s) has not selected a health care provider, assist them as needed.

    7. Discuss safe sleep practices with the parent(s). Provide resources as needed, to help the parent(s) prepare a safe sleeping area for the infant (see Forms and Tools: Infant Safe to Sleep Guidelines and Protocol).

    8. Discuss the health and substance use needs of other parents and/or adult family members in the home.

    9. Request the mother’s informed consent via the Authorization for Release of Information (ROI) to obtain or share information with providers (see policy 2.6 Information Management: Confidentiality/Safeguarding Information).

  5. Contact the mother’s healthcare provider(s) to assess compliance with prescribed medication and/or treatment plan and obtain written verification:

    1. Healthcare: Determine compliance with medication and any health-related needs

    2. MAT provider: Discuss and verify compliance with the treatment plan, for mothers participating in a MAT program.

  6. Contact the infant’s health care provider:

    1. Obtain information regarding any diagnosis, prognosis and medical care needs to assist in determining the specific care needs of the infant; and

    2. Obtain the medical records and any other pertinent information from healthcare providers e.g., hospital records, occupational therapy, pediatrician, discharge plan, growth chart.

  7. Complete and submit the Children 1st Referral and Screening Form for the infant and any other child in the home under the age of three for a development assessment (see policy 19.28 Case Management: Children 1st and Babies Can’t Wait).

  8. Develop, implement and monitor a Plan of Safe Care in accordance with policy 19.27 Case Management: Developing a Plan of Safe Care for Infants Prenatally Exposed to Substances of a Fetal Alcohol Spectrum Disorder (FASD).

  9. Submit the Special Circumstance Infants Prenatally Exposed to Substances (No Maltreatment) to the Social Services Supervisor (SSS) for approval within 45 calendar days from the receipt of the intake report.

    This assessment is not an investigation. Maltreatment codes will not be identified, and the allegation detail page will not generate.

Social Services Supervisor

  1. Conduct a staffing with the SSCM prior to the initial contact with the family to:

    1. Confirm the information reported meets the criteria for a Special Circumstance Infants Prenatally Exposed to Substances (No Maltreatment); and

      Assigned Special Circumstances Infants Prenatally Exposed to Substances (No Maltreatment) that do not meet the criteria for Infants Prenatally Exposed to Substances (No Maltreatment) must be referred back to the CPS Intake Communication Center (CICC) to processed and assessed as a child abuse report.

    2. Provide guidance on how to best engage the family and the assessment process.

  2. Document the supervisory staffing in Georgia SHINES within 72 hours of occurrence (see policy 19.6 Case Management: Supervisor Staffing).

  3. Ensure a face-to-face contact is made with the mother and infant within five weekdays of the receipt of the intake report.

  4. Assess the sufficiency of services recommended in accordance with policy 19.17 Case Management: Service Provision.

  5. Participate in the development and implementation of the Plan of Safe Care (see policy 19.27 Case Management: Developing a Plan of Safe Care for Infants Prenatally Exposed to Substances of a Fetal Alcohol Spectrum Disorder (FASD)). Review the Plan of Safe Care to ensure that the plan addresses:

    1. The health and substance use treatment needs of the infant and parent(s); and

    2. The needs of the other family members affected by the substance use.

  6. Ensure that the infant and any other child in the household who meets the eligibility criteria are referred to Babies Can’t Wait in accordance with policy 19.28 Case Management: Children 1st and Babies Can’t Wait.

  7. Review the Special Circumstance-Infants Prenatally Exposed to Substances (No Maltreatment) assessment and make an approval decision in Georgia SHINES within 45 calendar days of receipt of the intake report.

Practice Guidance

Exposure to substances has the potential to cause a wide spectrum of physical, emotional, and developmental problems for infants. The harm caused to the child can be significant and long‐lasting, especially if the exposure is not detected and the effects are not treated as soon as possible.[1] 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, Comprehensive Addiction and Recovery Act (CARA) 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.

The purpose of Special Circumstances Infants Prenatally Exposed to Substances (No Maltreatment) is to assess the impact of prenatal exposure on the infant’s health and development, as well as the needs of the mother and other family members to develop the Plan of Safe Care. Special Circumstances deals exclusively with infants’ prenatal exposure to substances that were legally prescribed and used by the mother during pregnancy. These assessments do not include prenatal abuse (i.e., use of illegal substances during pregnancy) or have indicators of child abuse. Examples of Prenatal Exposure with No Maltreatment:

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

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

The family should be engaged in a manner that builds consensus around their needs and encourages their participation in recommended services. It is important to explain to the parent(s) that this assessment is not to penalize the mother for using prescribed medications during pregnancy but to develop a plan that aids in identifying and addressing the infant and mother’s current and future well-being needs; and will include a collaborative effort between multiple agencies and supports such as Babies Can’t Wait (BCW), the pediatrician, family members, etc. For further information on the Plan of Safe Care see policy 19.27 Case Management: Developing a Plan of Safe Care for Infants Prenatally Exposed to Substances or a Fetal Alcohol Spectrum Disorder (FASD).

Forms and Tools

Infant Safe to Sleep Guidelines and Protocol
Know Your Rights: Rights for Individuals on Medication-Assisted Treatment
Notice of Case Record Information Available to Parents/Guardians
Notice of Case Record Information Available to Parents/Guardians (Spanish)
Notice of Privacy Practices
Notice of Privacy Practices (Spanish)

1. Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. Substance‐Exposed Infants: State Responses to the Problem. HHS Pub. No. (SMA) 09‐4369. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009