SUBSTANCE EXPOSED NEWBORNS AND CPS ALTERNATIVE RESPONSE Marlys Baker September, 2017
How did we get here? Three elements combined: Casey Family Programs (2014) Substance Exposed Newborn Task Force (2016) Comprehensive Addiction and Recovery Act (CARA) amendments to the Child Abuse Prevention and Treatment Act (CAPTA) (2016)
Casey Family Programs Evaluations demonstrate: children are at least as safe in AR cases parents are engaging in services, and families, caseworkers, and administrators are supportive of Alternative Response (AR).
Substance Exposed Newborn Task Force Traditional CPS responses and punitive responses, such as criminalizing substance use disorders in pregnancy, discourage women from seeking treatment and prenatal care
CARA Amendments to CAPTA Requires states to: Develop and monitor a Plan of Safe Care for infants born with and affected by all substance abuse or withdrawal symptoms or Fetal Alcohol Spectrum Disorder and their caregivers (whether there is an AR or standard assessment) Report specific data to the federal government
The Perfect Storm
Senate Bill 2251 Allows CPS to conduct an alternative response assessment when a CPS report concerning substance exposed newborns is received Mirrors the federal language for Plan of Safe Care, monitoring and referrals for services
CPS RESPONSE TO SUBSTANCE EXPOSED NEWBORNS
What is Alternative Response? Alternative response is a second response choice to a child protection report Beginning November 1, 2017 there will be a Standard CPS Assessment Response and an Alternative CPS Assessment Response for Substance Exposed Newborns.
What is the Purpose of the AR Assessment Response? To assure safety for the substance exposed newborn in the home To intervene early in the child s life to address needs for child safety and family support To build a support system around the infant/family for infant safety and continued support after the CPS assessment is closed
Key Points Research is showing that there are long term benefits for substance exposed babies who stay with their mothers: More developmentally advanced than SEN babies in foster care Reduced symptoms of Neonatal Abstinence Syndrome (NAS) Research also indicates that the period following birth offers a window of opportunity to engage caregivers in successful treatment
Key Points Substance Exposed Newborns are a very vulnerable, HIGH RISK population If an infant is placed in danger, an AR response is no longer appropriate no exceptions
Similarities to Standard CPS Assessments Alternative Response is a CPS assessment NOT an In Home Program. CPS reports (SFN 960s) of substance exposed newborns are required from mandated reporters Category assignment and face-to-face contact policies apply (SEN reports are Category B) Time frame for assessment remains 62 days All FRAME entry is required AR Assessments will be staffed with CPTs
Similarities Both types of CPS assessments require a Safety Plan and a Plan of Safe Care for the newborn and caregivers Both types of CPS Assessment require service referrals and monitoring
How Alternative Response is Different AR applies only to reports of substance exposed newborns (28 days and less at the time the CPS report is received) NDCC 50-25.1-02-17
Differences Federal law requires notification to CPS for: infants born with and affected by substance abuse or an infant experiences withdrawal symptoms or is impacted by Fetal Alcohol Spectrum Disorder Under state law, this notification takes the form of filing a report with CPS (SFN 960)
Differences Infants affected by : ABUSE of alcohol (chronic and severe) or USE of a controlled substance for a non-medical purpose (drug use) or withdrawal symptoms (NAS or symptoms) or Fetal Alcohol Spectrum Disorder in the infant
Differences withdrawal symptoms (NAS or symptoms) Example: Mother on Medication Assisted Therapy (MAT) Infant exhibits NAS symptoms MAT is not use of a controlled substance for a NONMEDICAL purpose, Yet, the infant is affected. This is reportable under federal law.
NEW Suspected Maltreatments
Also New
SUSPECTED MALTREATMENTS Prenatal Exposure to Opioids Fetal Alcohol Spectrum Disorder Neonatal Abstinence Syndrome Alcohol present at birth Drugs other than meth present at birth Meth present at birth Prenatal exposure to alcohol Prenatal exposure to drugs other than meth Prenatal exposure to meth
Differences The assessment is needs based, not a fact finding process to enable a determination Participation in AR is voluntary No determination of abuse or neglect is made
Offer AR when: There has been a previous Pregnant Woman assessment and the mother engaged in service planning and development of a Plan of Safe Care for the infant The initial report concerns an infant within the first 28 days of life The concerns reported involve only prenatal exposure to abuse of alcohol or use of a controlled substance and there are no other children involved where there are concerns of abuse or neglect
Offer AR when: The initial report indicates that this is the first birth to this mother, or There is no previous CPS history concerning the mother or other caregivers; or There is a history of previous CPS reports involving the mother or other caregivers that were administratively assessed, or terminated in progress or determined no services required, or
Offer AR when: There was a previous services required determination for neglect and the parent followed through with required services, working successfully with the case manager, or The newborn, or other siblings or household members, are not currently in the care and custody of a county or the Department;
Offer AR when: The parent has no intellectual limitations that may impair the parent s ability to nurture or physically care for the child, or The parent has no major psychiatric illness not currently controlled with medication,or There is no current or recent history (within 6 months) of domestic violence in the home with the current partner
AR will not be used when: The initial report contains abuse or neglect concerns for the newborn or other children in the home in addition to substance exposure, or The newborn affected by substance exposure is over 28 days old, or There is a current open assessment involving abuse or neglect concerns other than prenatal substance exposure, or
AR will not be used when: There is a history of previous CPS assessments with services required determination related to: physical abuse sexual abuse medical neglect recent assessment with a services required determination (within six months)
AR will not be used when: There is a history of: non-organic failure to thrive or death of a child from abuse or neglect or undetermined injury or death of an infant The newborn, or other siblings or household members, are currently in the care and custody of a county or the Department, or The parents/caregivers refusal
Agreement Participation in an AR assessment is voluntary! If parents choose not to participate in an AR assessment, a Standard CPS Assessment MUST be completed when there are maltreatment concerns.
Standard Assessment Substance exposed newborns in a standard assessment must still have a Plan of Safe Care, the Plan must be monitored and appropriate referrals for the newborn and caregivers must be made!
AR ASSESSMENT
What Will Happen in Alternative Response Assessments? If a CPS report meets criteria for an AR assessment, it will be assigned to a CPS worker to complete The worker will offer Alternative Response assessment to the caregivers whenever determined appropriate
5 Parts of an AR Assessment Work with the family to : 1. develop the Safety Plan, 2. develop/complete a Needs Assessment, 3. develop/complete a Plan of Safe Care 4. make Referrals for services and 5. Monitor the plans
When Caregivers Agree When a caregiver agrees to participate in an Alternative Response Assessment the caregiver will sign an agreement to: Engage in and follow the Plan of Safe Care for themselves and their infant Follow the Safety Plan for the infant Sign all necessary releases of information
When Caregivers Agree Caregivers will help identify 3 or more Safety Support Persons to support safety for the infant and assist the parent(s) through the process of change. Safety Support persons can be formal or informal supports (friends, family, AA sponsor, etc.) Safety Support Persons will sign an agreement to monitor infant safety and provide support.
How is an AR Assessment Done? The worker will use Protective Factors to assess the needs of the infant and the infant s caregivers Plan of Safe Care and service referrals will be made within 30 days and monitored by the worker for at least 30 days One timeline extension can be requested
Protective Factors
Protective Factors Protective factors are conditions or attributes of individuals, families, and communities that both mitigate risk factors and actively enhance well-being. AR Assessments will focus on Protective Factors
Protective Factors Concrete Supports Knowledge of Parenting and Child Development Social Connections Parental Resilience Social and Emotional Competence of Children *Center for the Study of Social Policy
Needs vs Services A need is: Circumstances in which something is necessary, or that require some course of action; necessity A service is: A system supplying a need such as transport, communications, or utilities
Needs vs Services No one needs treatment services! However, infants need safe, drug free environments. Parents need to safely care for their infant. The need is safe environment or safe care, the service to meet the need may be: A&D evaluation, day treatment, inpatient treatment, AA/NA, etc.
Needs vs Services No one needs parenting classes, but may need better understanding of child development. The need can be met through: parenting classes, self teaching material, mentoring/modeling (parent aide, breast feeding coach, etc.) There are many ways to address an identified need Think about developing a menu of service options when talking about needs.
CPT Staffing/Needs Assessment CPTs will be used for assistance in identifying resources and services not to aide in making a determination Staffing with CPT should be done whenever possible and as early as possible after meeting with the family CPT staffing should occur as part of Needs Assessment and service referral rather than at the conclusion of the assessment
Can an AR Assessment be terminated in progress? Yes, when: the information found early on in the assessment process leads the CPS Worker to believe the concern falls outside the definitions in the Child Abuse and Neglect law, (NDCC 50-25.1) the assessment may be terminated in progress (AT). Examples include: Reports of infants affected by withdrawal symptoms or FASD who do not meet the definitions of abuse/neglect in state law and the parents decline AR The baby is released for adoption and parental rights are terminated (may offer services for the infant) Information gathered during the assessment indicates the newborn was not substance exposed
AR but NOT Standard Assessment Federal law applies to infants affected by Withdrawal Symptoms Receiving Medication Assisted Therapy or other medication, for a medical reason, is NOT use of a controlled substance for a nonmedical purpose (state law) Yet these legal substances can cause NAS in a newborn
AR but NOT Standard Assessment Offer AR. If accepted, the following apply: Safety Plan Plan of Safe Care Needs assessment Referrals for Services Monitoring If AR is declined, Terminate the Assessment in Progress.
AR but NOT Standard Assessment SO: Infants affected by medical use WOULD be reportable and eligible for AR, but Infants affected by medical use would NOT meet a definition of abuse/neglect and NOT receive a standard assessment.
What if the Family Won t Cooperate? The AR response is voluntary. Caregivers do not have to participate in an AR assessment HOWEVER A CPS assessment of a report of suspected child abuse or neglect must still be completed whenever there are abuse/neglect concerns An AR assessment can be changed to a Standard CPS Assessment at any time before approval/denial of the assessment. A Standard Assessment cannot be changed to AR!
Reverting to a Standard Assessment Consideration for reverting to a Standard Assessment type should be given for the following reasons: Violation of AR Agreement placing the infant in danger Violation of Plan of Safe Care Receipt of additional reports unrelated to the SEN When the assessment necessitates contact with law enforcement
Reverting to a Standard Assessment The newborn, or other siblings or household members have been taken into custody Parental / Caregiver Protective Factors are inadequate to ensure child safety Lack of participation in services as confirmed by the service provider Lack of cooperation and / or refusal to participate in the Alternative Response Assessment
BE SURE BEFORE YOU USE THIS OPTION! THIS IS A VERY COMPLEX AND EXPENSIVE DATA FIX!
PLAN OF SAFE CARE
Is a Plan of Safe Care the Same as a Safety Plan? No!
Safety Plan A CPS Emergency Plan for Child Safety is intended to control threats of danger/safety concerns over the period of the assessment (short term) A CPS Emergency Plan only addresses threats of danger that can be immediately identified or foreseen in the near future
What is a Plan of Safe Care? A Plan of Safe Care is a plan to address the health, safety and substance abuse treatment needs of the substance exposed newborn and the health and substance abuse treatment needs of the infant s caregivers. Plan of Safe Care is going forward Plan of Safe Care is a federal requirement for all SENs
Plan of Safe Care The Plan of Safe Care has three parts: Plan of Safe Care as constructed in FRAME (including Safety Support agreements (attachments); List of identified needs as listed in the Staffing Notes (use the tool in the field); and Service Outcomes for the assessment. Each infant & each Caregiver has a Plan of Safe Care
Add Plan of Safe Care Add Team Staffing Notes
Infant Plan of Safe Care Required Elements for Infants: Health Routine medical care Safe sleep information Safe housing free of substance exposure Verify Period of Purple Crying information Substance Use Disorder Treatment Needs Referral to Early Intervention Services (Part C referral) Screening and any treatment follow up for NAS or SEN Safety Supports in the event of relapse Optional Elements can include any other needs identified
Caregiver Plan of Safe Care Required Elements for caregivers: Health needs Pregnancy and Post Partum medical care/follow up Medical follow up regarding any health conditions SUD Treatment needs Referral to Substance Use Disorder Evaluation/Treatment Ongoing recovery supports Relapse/crisis plan Number of Safety Supports Optional Elements can include any other needs identified
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Monitoring the Plan of Safe Care There is a federal requirement to monitor the plan of safe care The required elements of the Plan of Safe Care must be completed within 30 days to allow at least 30 days to monitor Monitoring the Plan of Safe Care will be done through contacts with caregivers, safety supports and service providers
Monitoring Monitoring will include multiple contact methods (face-to-face, phone, text, etc.) Monitoring activities will be documented in the CAL
Monitoring the Plan of Safe Care Weekly contacts with parent(s)/caregivers/infant: every other week must be face to face, with the parents/caregivers and the infant Any other children in the home must be assessed for safety during contacts throughout the assessment. At least one face-to-face, or via electronic means, visit with each participant who agrees to act as a Safety Support for the infant in the Plan of Safe Care
At least four follow up contacts (phone, email, text, etc.) with each participant who is an informal support. Contacts with service providers or follow up contacts with informal supports can be made by phone, email, in writing, text message, etc. to verify follow through with the plan. Mandatory contact with service providers before the case is closed.
Monitoring the Plan of Safe Care
Protective Factors will be Documented in FRAME The Family Assessment Instrument will be used to document the AR Assessment There is new guidance about what to enter into each of the 21 factors Ratings remain the same Changing to a Standard CPS Assessment should be considered when more than 1 of the ratings for caregiver factors are High
Conclusion of the AR Assessment AR assessments will be closed without a determination of whether services are required or May be referred to In Home Services
Closing the AR Assessment Documentation narrative should address questions such as: Is the child safe? Do the current protective factors warrant case closure? What progress and changes, if any, have occurred with respect to the conditions and behaviors contributing to the risk of maltreatment? What is the evidence of accomplishment?
Closing the AR Assessment Have the services been effective in helping the family achieve their goals and, if not, what adjustments need to be made to improve outcomes? Have the risk factors been reduced sufficiently so that parents or caretakers can protect their children and meet their developmental needs? Are the family members ready to have their case closed? Are the parents(s), other caregivers, Safety Support persons and service providers willing and ready to ensure the ongoing safety and well-being of the infant.
Required Documentation Location of required documentation: Family Assessment Instrument The Family Assessment Instrument is required to be completed in FRAME. Reference: Guidelines for Completing the Twenty-One Factors: Alternative Response for Substance Exposed Newborns, include Protective Factors here Supporting Documents folder in the CPS Manual Appendix
Required Documentation Case activity Log: Document assessment contacts Document monitoring the Plans of Safe Care in the FRAME case activity log using the selection, Monitor Plan of Safe Care. All assessments with a Plan of Safe Care must include monitoring documentation. FRAME Plans Tab Document completion of the "Plan of Safe Care" in FRAME under the Plans tab (and linked from the Assessment tab)
Required Documentation Team Staffing Notes Any needs/service recommendations made by the Child Protection Team the Team Staffing Notes section of FRAME Document non-compliance with the AR assessment or Plan of Safe Care Document the decision to revert to a Standard Assessment agreement of worker, county supervisor and Regional Supervisor in the Team Staffing Notes section of FRAME
Required Documentation Document in the staffing notes CPS Workers review of the Safety Plan, Plan of Safe Care and level of risk in the family prior to case closure Document county supervisor and Regional Supervisor agreement with case closure
Required Documentation Service Outcomes Federal Requirement Making referrals and delivering appropriate services for the infant and affected family or caregiver Document ALL service referrals for the newborn and for the caregivers
Required Documentation Attachments SFN 960 Any related medical records AR Agreement Safety Support Agreements Written list of needs and services
Data Reporting The number of infants identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or a Fetal Alcohol Spectrum Disorder The number of infants with safe care plans The number of infants for whom service referrals were made, including services for the affected parent or caregiver
Tools Brochure/handout for parents about AR Information for mandated reporters about SEN & AR AR agreements with Caregivers & Safety Supports Guide for Family Assessment Instrument (21 factors) Template for needs and services
Keys for success Collaboration Collaboration Collaboration! Please engage your partners at the local level, inform your communities, seek new partnerships to make AR successful for our families!
QUESTIONS? mbaker@nd.gov