In regulation: The department shall investigate all reports alleging that a newborn infant has been prenatally exposed to alcohol or a controlled legal or illegal substance. A newborn infant who has been prenatally exposed to alcohol or a controlled legal or illegal substance, or is demonstrating withdrawal symptoms resulting from controlled substances, is considered vulnerable to abuse or neglect. The overall substance use by the parent (including prenatal drug use, whether prescribed or not) and the parents' ability to perform essential parental responsibilities must be considered in the assessment of the newborn's safety. Assessment of the Infant and Family Citation: Pol. & Proc. Man. Ch. 2, § 11.1 For the family functioning assessment, the department shall complete the following: Gather information concerning the medical condition of the newborn, including any complications from the substance exposure, the discharge status and instructions (where applicable), and any recommendations for follow-up medical care If available, obtain documentation from the health-care professional(s) about the newborn infant's prenatal substance exposure, including the following: – Clinical indicators in the prenatal period, including maternal and newborn infant presentation – Information regarding history of substance abuse or use by the mother – Medical history – Toxicology results and/or other laboratory test results on the mother and the newborn infant Obtain information from the health-care professional(s) regarding their observations of the parental responsiveness to the newborn, visitation, feeding, understanding of the newborn's special needs, or any other information to assist in the safety assessment and development of the infant care plan Obtain the hospital discharge plan and recommendations from the health-care professional about postdischarge infant care and medical follow-up Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 10 If the newborn is hospitalized at the time of the report, visit the newborn's home environment prior to the newborn's discharge Obtain the names and contact information of the health-care professionals who will provide routine health care for the newborn and any recommended special medical care Gather information to assess family functioning, threats of danger, and parent/caregiver protective capacities in a family, including the following regarding the parent or caregiver: – Any history of depression, anxiety, or other mental health concerns – Any history of substance use, including the types, frequency, and amount of drugs used – Any history of substance-exposed newborn births – Any history of participation in substance abuse treatment services and other prevention or intervention services – The perception of his or her caregiving role and responsibilities – The plan to meet the newborn's basic needs for shelter clothing, medical care, etc. – Whether tobacco is smoked in the home and plans to discontinue use – Identification of the proposed caregivers of the newborn on a daily basis and when the mother is unavailable and whether that caregiver has the ability to provide safe care to the newborn – Sleeping arrangements, including assessment of whether the infant has a safe sleep environment – History of parenting, including parenting of siblings in the past or currently – Knowledge of child development and behavior management, including the adequacy and accuracy of this information If the parent is engaged in medically assisted treatment (MAT) to control an opioid addiction, obtain information about the parent's treatment progress For infants suspected of having fetal alcohol spectrum disorder (FASD), obtain the following as soon possible or within 1 year: – Documentation of the diagnosis by a health professional indicating clinical findings consistent with FASD – The child's medical records – The health professional's recommendations for services for the child Responsibility for Development of the Plan of Safe Care Citation: Pol. & Proc. Man. Ch. 2, § 11.1 The department shall develop an infant care plan for newborn infants who were prenatally exposed to alcohol or a controlled substance by the mother and children up to age 1 who were diagnosed with fetal alcohol spectrum disorder. The department shall collaborate with health-care professionals and local substance abuse assessment and treatment providers, when available, to assist in the investigation, assessment, and delivery of quality services for infants who have been prenatally exposed to alcohol or a controlled legal or illegal substance, and their families. The department will develop an infant care plan for the newborn infant who was prenatally exposed to alcohol or substance use by the mother or child up to age 1 diagnosed with FASD. The department will actively involve the parents or caregivers, the infant's health-care professionals, the parents' or caregivers' substance abuse treatment service providers, MAT providers, out-of-home care providers, and supportive adults identified by the parents or caregivers (if applicable) to develop the infant care plan. Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 11