sen online presentation - und · ^ e k v o ] v d ] v ] v p d } µ o í $4'#-+0) 0'95 8li...
TRANSCRIPT
![Page 1: SEN Online Presentation - UND · ^ e k v o ] v d ] v ] v p d } µ o í $4'#-+0) 0'95 8li '47 6iwtsrwi xs 7yfwxergi )\tswih 2i[fsvrw 0mzi $4'#-+0) 0'95)jjigxmzi 2sziqfiv 2( lew e 7xerhevh](https://reader034.vdocuments.site/reader034/viewer/2022043015/5f3840b4794e0317c0225903/html5/thumbnails/1.jpg)
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BREAKING NEWSThe CPS Response to Substance Exposed Newborns
Live
BREAKING NEWS
Effective November 1, 2017, ND has a Standard CPS Assessment Response and an Alternative CPS Assessment Response for Substance Exposed Newborns
LIVE
Learning Objectives
• Participants will understand the statutory background guiding the CPS Response to Substance Exposed Newborns.
• Participants will understand the two CPS assessment responses to reports involving Substance Exposed Newborns and when to utilize each response type.
• Participants will understand how to apply the Protective Factors to assessments involving Substance Exposed Newborns and their families.
• Participants will be able to identify the requirements for Plans of Safe Care.
Who are the Substance Exposed Newborns (SEN)?
NDCC 50-25.1-02(18)
Substance Exposed Newborns (SEN)
ND Century Code defines a substance exposed newborn (SEN) as an infant younger than 28 days of age at time of the initial report of child abuse or neglect and who is identified as being affected by substance abuse or withdrawal symptoms or by a fetal alcohol spectrum disorder.
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CPS Response to SEN – How did we get here?
01CAPTAChild Abuse Prevention and Treatment Act
02CARA 2016 Amendments Comprehensive Addiction and Recovery Act
03North Dakota LegislatureSubstance Exposed Newborns Task ForceSB 2251 (65th Assembly)
04North Dakota Child Welfare CommunityCasey Family ProgramsNDDHS Policy 640-37
CPS Response to SEN – How did we get here?
• Research reviewed indicates:
• Children were at least as safe in AR cases
• Parents were engaging in services• General support for AR from families,
caseworkers, and administrators• Traditional CPS responses and
punitive responses discouraged women from seeking treatment and prenatal care
• Senate Bill 2251 created the AR in 2017 and the CPS Task Force assisted in the development of the policy and forms we have today.
BREAKING NEWS
CPS Response to Substance Exposed Newborns
01SR or ARThere is a Standard Response (SR) or an Alternative Response (AR) for CPS when responding to reports involving SENs.
02Assess Safety of NewbornEither response will assess the safety of newborns prenatally exposed to substances and to develop a plan of safe care for the newborn(s) and their caregiver(s).
03Purpose Statement #1Intervene early in the child’s life to address needs for child safety and family support.
04Purpose Statement #2Build a support system around the newborn/family to be the ‘eyes and ears’ for child safety after CPS ends.
BREAKING NEWS
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What is Alternative Response?
Provide referral servicesProvide referral services and monitor support
services for a person responsible for the child’s welfare and the substance exposed newborn.
Plan of Safe CareDevelop a plan of safe care for the substance exposed newborn and their caregiver(s).
No Maltreatment DecisionAn AR assessment does not result in a maltreatment decision. There is no determination about services being needed for the protection and treatment of an abused child.
Why Alternative Response?
• Research is showing there are long term benefits for SEN who stay with their biological mother:
• Infants are more developmentally advanced than SEN’s in foster care
• Infants displayed reduced symptoms of Neonatal Abstinence Syndrome (NAS)
• The period following birth offers a window of opportunity to engage caregivers in successful treatment
BREAKING NEWS
Similarities between AR and SR
ReportsCPS reports, or 960’s, of substance exposed newborns are required from mandated reporters.
Category BSEN reports are a Category B report. Initiation and face-to-face contact requirements are the same.
TimeTime frame for assessment remains 62 days.
FRAMEAll FRAME entry is required.
CommunityCommunity members are a resource in both response options.
PlansPlans of Safe Care are required in both types of CPS assessment responses.
CPSAR is a CPS assessment, not an In-Home program response.
C R C T F C P
Daily News
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BREAKING
NEWS LIVE
Safety PlansSafety is assessed in both CPS Assessment response types. Safety Plans are utilized as determined on a case by case basis.
MonitoringPlans of Safe Care must be monitored
in both types of CPS Assessment responses.
Referrals to ServiceBoth types of CPS Assessment
responses require service referrals based on family’s
identified needs.
Similarities between AR and SR
Differences between AR and SR
Notification
Federal Law requires “Notification” to CPS for infants affected by substance abuse.
NeedsThe AR assessment is “need based”, not a fact-finding process to enable a finding.
VoluntaryParticipation in an AR assessment is voluntary.
No Decision
No finding of abuse or neglect is made. The evidence-based screening tool is not used.
Engagement
How families experience and engage in the process can be different.
SENAR applies only to reports of SEN. AR cannot be used as a response to other reports.
S N N V N E
Daily News
Difference between AR and SR further revealed
NEWS
EXAMPLE
Report of withdrawal symptoms (NAS or symptoms)
• Mother on Medication Assisted Therapy (MAT)
• Infant exhibits NAS symptoms• MAT is not use of a controlled
substance for a non-medical purpose
• Yet, the infant is affected
This is reportable under federal law and notification to CPS must occur.
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INTAKE Reminders
Substance Use & TreatmentInformation on prior substance use during
pregnancy, mother’s toxicology at birth, substances that affected the infant and mother’s history of SUD treatment are necessary pieces to
gather during the intake process.
Housing SituationWhat is the date/time of planned discharge from the hospital and what is the family’s housing situation are also key pieces of information during intake.
Legal InvolvementAre there any outstanding criminal charges pending? Has the birth mother expressed to anyone she is considering making an adoption plan for the infant?
See CFS Policy 640-37 for more details
The Alternative Response Assessment will not be used.........
01Other Abuse/Neglect Alleged The report contains abuse or neglect concerns for the newborn or other children in home in addition to substance exposure.
02Over 28 days oldThe report involves a newborn affected by substance exposure who is over 28 days old.
03Open CPS regarding other A/NThere is a current open assessment involving abuse or neglect concerns other than prenatal substance exposure.
04Certain previous CPS findingsThere is a history of CPS assessments with a Services Required determination related to PHAB, SXAB, MDNG, or a recent assessment with a Services Required determination.
The Alternative Response Assessment will also not be used.....
History of Serious HarmThere is a history of non-organic failure to thrive,
death of a child from abuse/neglect or undetermined injury or death of an infant.
Children/Siblings in Foster CareThe newborn, other siblings or household members are currently in the care, custody and control of a county or the Department.
Caregiver RefusalThe parents or caregiver(s) refuse to participate in the Alternative Response assessment.
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The Alternative Response Assessment can be offered when.....
Caregiver engagingThere has been a previous pregnant
woman’s assessment and the mother engaged in service planning
and development of a Plan of Safe Care.
01No abuse/neglect foundAny previous reports involving the mother or other caregivers were AA, TIP, or had a no services required finding.
03
Prenatal Exposure Concerns 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.
04Infant birth thru 28
days of ageThe initial report concerns an
infant within the first 28 days of life and there has been no prior
reports of maltreatment.
02
The Alternative Response Assessment can be offered when.....
First BabyThere has been a previous pregnant
woman’s assessment and the mother engaged in service planning
and development of a Plan of Safe Care.
01No Caregiver LimitationsThe parent has no intellectual limitations that may impair the parent’s ability to nurture or physically care for the child. Any major psychiatric illness is controlled with medication.
03
No Domestic ViolenceThere is no current or recent history (within 6 months) of domestic violence in the home with the current partner.
04Completed prior
services for neglectThere was a previous SR
determination for neglect and the parent followed through with
required services, working successfully with the case
manager.
02
Notes about offering the Alternative Response Assessment
BREAKING NEWS
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The Aternative Response Assessment – a closer look
NEWS
BREAKING
NEWS LIVE
Signed SFN 495Once the agency and caregiver(s) agree to proceed with the AR assessment, an official agreement is signed and the worker can continue with the process.
Initial VisitCPS worker reaches out to
caregiver(s), has face-to-face contact with the newborn, and possibly the reporter. Brochures are provided.
IntakeInformation received in the report
and initial background checks indicate AR is a viable option.
The Beginings of an AR Assessment
Components of the AR Assessment
Needs Assessment
Informed by the 5 Protective Factors, needs are assessed.
Safety Supports
Identify Safety Supports for family. SFN 497 is secured for those participating.
Plan of Safe Care
Develop and complete a Plan of Safe Care for infant(s) and caregiver(s).
Referrals
Referrals for services to address the identified needs are made.
Monitor
Monitor the Plan of Safe Care for 30 days.
Safety Plan
Safety and risk are always assessed and addressed.
S N S P R M
Daily News
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When Caregiver’s Agree......
NEWS
I agreed to what?
When the caregiver(s) agree to participate in the AR assessment, the caregiver will sign an agreement. By signing, they are agreeing to work with CPS to:
• Engage in and follow the Plan of Safe Care
• Follow the Safety Plan, if applicable• Sign all necessary releases of
information• Remember, caregivers can have a
night to consider their options.
Wanted: Safety Support Persons
Formal or InformalSafety Support persons can be formal or
informal supports, such as friends, family, AA sponsor, etc.
Solidify Agreement in writingSafety Support Persons will sign an agreement (SFN497) to monitor infant safety and provide support.
How many are needed????The need for “3” support persons as outlined in policy is not intended to be a barrier. Some caregivers may have very few and limited supports available and may express difficulty in identifying three such individuals.
Protective Factors…. A closer look
Protective factors are conditions or attributes of individuals, families, and communities that both mitigate risk factors and actively enhance well-being.
• 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
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Protective Factors…. A closer look
Need
..a lack of something requisite, desirable, or useful; a physiological or psychological requirement for the well-being of an organism
Service
..the action of helping or doing work for someone; a system suppling a public need such as transport, communications, or utilities
BREAKING NEWS
Concrete Supports in Times of Need…. A closer look
When working with families who struggle with Substance Use Disorders, what kind of concrete supports do they typically need?
• Safe drug-free housing• Financial Assistance• Infant care needs (clothing, safe
sleep, formula, other supplies)• Legal needs• Access to medical treatment• Access to mental/behavioral health
treatment
BREAKING NEWS
Concrete Supports in Times of Need...... Identifying Strengths
Strength or Risk?
• Can parents identify concrete needs?
• Can they locate where to access concrete services?
• Do they understand their rights to receive services?
• Do they know how to navigate the system to access services?
• Do they have basic financial security to cover basic needs and unexpected costs?
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Knowledge of Parenting and Child Development…. A closer look
All new parents have a learning curve with a new baby in understanding issues related to child development:• Physical, cognitive, language, etc.• Recognizing signs of delays• Cultural considerations• How to positively impact behavior
When Substance Use Disorder concerns are present:• Can child’s needs come first• How addiction impacts attachment• How addiction impacts expectations
BREAKING NEWS
Knowledge of Parenting and Child Development..... Identifying Strengths
Strength or Risk?
Seeking, acquiring, and using accurate age and stage-related information in parenting:• observing caregiver and infant
for signs of early secure attachments
• caregiver has appropriate developmental expectations
• caregiver can recognize and attend to the special needs of infant
Questions workers can ask:• How have you learned about
parenting skills?• Are there things that worry you
about your child’s behavior?
Social Connections…. A closer look
Social connections provide emotional support, informational support, instrumental support and spiritual help.
New parents with a substance use disorder may have few connections that do not involve the use of substances.
Social connections may be weakened with their support system as their addiction increases.
A new parent feels isolated in the best of circumstances!
BREAKING NEWS
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Social Connections...... Identifying Strengths
Strength or Risk?• Do caregivers have friends or
family members that help? • Do caregivers find it easy or
challenging to make friends?• How many supportive
relationships are readily available to caregivers?
• Are caregivers a member of any groups or organizations?
Parental Resilience…. A closer look
Parental resilience is the process of managing stress and functioning well when faced with stressors, challenges, or adversity.
• Utilizing inner strengths to meet challenges
• Providing nurturing attention to child despite present stressors
• Seeking help for self or child when needed
Parental stress is caused by the pressures placed on parents personally and in relation to their child.
BREAKING NEWS
Parental Resilience...... Identifying Strengths
Strength or Risk?
• What kinds of worries and frustrations are there?
• How are these frustrations or problems solved?
• How are the infant/children’s needs met when caregiver is stressed?
Focus on the presence or absence of problem-solving skills, ability to cope with stress, self-care strategies and help seeking behaviors.
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Social-Emotional Competence of Children…. A closer look
The dimensions of social-emotional competence in early childhood includes things such as:
• Self-regulation/self-control• Communication skills
The social and emotional competence of children develops as a result of providing an environment and experiences that enable children to form close and secure relationships, and to experience, regulate, and express their emotions.
BREAKING NEWS
Soical-Emotional Competence of Children...... Identifying Strengths
Strength or Risk?
• Observe how emotionally responsive the caregiver is to the infant.
• Can the caregiver separate emotion from actions?
• Does the caregiver display an understanding of the principles of the “Period of PURPLE Crying”?
Protective Factors…. A closer look
Cross-walking Protective Factors and the Family Assessment Instrument –
Resources
CFSTC Website:https://www1.und.edu/centers/children-and-family-services-training-center/nd-alternative-response.cfm
BREAKING NEWS
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Reaching out to Community Resources during the CPS Response to SEN
Resources IdentifiedChild Protection Teams are used
for assistance in identifying resources and services.
01Needs & ServicesConsultation with CPT’s should occur as part of Needs Assessment and service referral rather than at the conclusion of the assessment.
03
No Team?Reach out to community resources to assist development of and adjustments to the Plan of Safe Care.
04Early Involvement
Staffing with CPT’s should be done as early as possible and
could happen as soon as after meeting with the family.
02
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. 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 or referrals)
• No evidence the newborn was prenatally exposed
BREAKING NEWS
Can CPS Offer AR but NOT be requiredto complete the SR?
Yes, federal law applies to infants affected by withdrawal symptoms
• Medication Assisted Treatment or other medications for a medical reason can cause NAS in a newborn
• But, this is NOT use of a controlled substance for a non-medical purpose (state law)
Offer AR. If accepted, all components of the AR apply. If MAT is verified and caregiver declines, the assessment can be Terminated in Progress.
BREAKING NEWS
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What if the Family won’t cooperate?
Assess reasons behind refusal
Remember the AR assessment is voluntary
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 SR Assessment at any time before approval/denial of the assessment but a SR Assessment cannot be changed to AR
BREAKING NEWS
Reverting AR to a SR Assessment
Consideration for reverting to a SR Assessment should be given for the following reasons:
• Violation of the Safety Plan 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 • Refusal to participate in the
Alternative Response Assessment and there are outstanding maltreatment concerns
BREAKING NEWS
Plan of Safe Care…. A closer look
“Our investigative reporter learned that Plans of Safe Care are required in any CPS response to a Substance Exposed Newborn and these Plans of Safe Care should not be confused with Safety Plans. Marlys Baker, CPS Administrator for the North Dakota Department of Human Services, revealed in an interview earlier this week that the only time a Plan of Safe Care will not be used is when an assessment is Terminated in Progress. We’ll go to our reporter in the field for more details, Stan…..”
BREAKING NEWS
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Safety Plan vs. Plan of Safe Care
Safety Plan
• Intended to control threats of danger/safety concerns
• Only address threats of danger that can be immediately identified or foreseen in the near future
Plan of Safe Care
• Addressed the health, safety and substance abuse treatment needs of the SEN(s) and caregiver(s)
• “Going Forward” focus
• Required in all situations involving SENs
BREAKING NEWS
Plan of Safe Care
Infant & Caregiver
The Plan of Safe Care is contained in three parts:
• “Plan of Safe Care” page as constructed in FRAME (upload Safety Support agreements)
• List of identified needs as reflected in the Staffing Notes section of FRAME
• Service Outcomes entered into FRAME
Each SEN and caregiver has to be addressed in the Plan of Safe Care
BREAKING NEWS
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Plan of Safe Care – Infant Components
Health Needs• Routine medical care• Safe sleep information• Safe housing free of substance
exposure• Verify Period of PURPLE Crying
information
SUD Treatment Needs• Referral to Early Intervention
Services (Part C referral)• Screening and any treatment follow
up for NAS or SEN complications• Safety Supports in the event of
caregiver’s relapse
Optional Elements, if applicable
BREAKING NEWS
Plan of Safe Care – Caregiver Components
Health Needs• Pregnancy and Post Partum medical
care/Follow up• Medical follow up regarding any
health conditions• MAT Oversight (if applicable), and• Pain Management (if applicable)
SUD Treatment Needs• Referral to Substance Use Disorder
Evaluation/Treatment• Ongoing recovery supports• Relapse prevention plan• Number of Safety Supports
Optional Elements can include any other needs identified
BREAKING NEWS
Monitoring Plans of Safe Care
30The required elements of the Plan of Safe Care
must be completed within 30 days to allow at least 30 days to monitor.
Multiple Contact MethodsMonitoring takes place through multiple contact methods (face-to-face, phone, text, etc.) with support persons, service providers and family.
Document in CALMonitoring activities will be documented in
the CAL. (Look for the specific contact type ‘Monitoring Plan of Safe Care’ in FRAME.)
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Monitoring the Plan of Safe Care – a closer look
Family ContactsWeekly contracts are required with caregivers and infant. Every other
week must be face to face. Any other children in the home must be
assess during contacts.
01Service ProvidersContacts with service providers while monitoring the Plan of Safe Care can help verify the caregiver’s follow-through, participation and progress with the plan.
03
Considering ClosureEnsure the community and natural supports/resources developed during services are stable and available to remain involved as long as needed by the family after the agency involvement ends.
04Contact with Safety
SupportsThere needs to be at least one
visit with each Safety Support in the Plan of Safe Care. Can be
face-to-face or via electronic means. These contacts must
occur at least every other week.
02
Relapse Planning and Relapse Considerations
• Relapse is a component of the recovery process yet relapses pose a challenge in determining progress.
• The CPS worker, in collaboration with drug and alcohol treatment providers, can assure that safe care for the infant is included in any relapse prevention plan developed with the caregiver and treatment provider.
• CPS workers should communicate with caregivers that the infant will not be removed from their care due to a relapse so long as safety plans are followed and the infant is not placed at risk during a relapse or threatened relapse.
BREAKING NEWS
Closing an AR Assessment
Agreement
Review with supervisor and Regional Office agreement for closure.
Document
Document results of review in the Staffing Notes section of FRAME.
Risk FactorsService Outcomes
Document ALL child and caregiver risk factors AND service referrals for the newborn and caregivers.
Uploads
Upload required attachments into FRAME.
FRAME
Submit assessment for approval. Once approved, close or transfer the case in FRAME according to case situation.
Review
Review the safety plan, Plan of Safe Care, and level of risk in the family.
R A D RFSO U F
Daily News
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SEN Online Training Module
18
Tools & Resources
BREAKING NEWS
BREAKING NEWS
Effective November 1, 2017, ND has a Standard CPS Assessment Response and an Alternative CPS Assessment Response for Substance Exposed Newborns.
LIVE
For more information, please visithttps://www1.und.edu/centers/children-
and-family-services-training-center/index.cfm
orhttp://www.nd.gov/dhs/services/childfamily
/cps/
A certificate of completion is available.