1. 8/28/2018
An Overview of DCFS’ Work with Substance Exposed Newborns Together we Can! Conference November 7-9, 2017 Lafayette, LA
Presentation: Tuesday, November 7th - 1:45pm - 3:15pm
Facilitators: Mona Michelli, DCFS State Office-CPS Program Chasity Williams, DCFS – Lafayette Parish
Darce’ Byrd – Lafayette Family Preservation Court

2. Review of Existing Policies, Procedures and Statistics
8/28/2018
Objectives
Review of Existing Policies, Procedures and Statistics
Impact of Opioid Use on Direct Field Practice
Review federal legislation changes regarding the Opioid epidemic and possible implications on Child Welfare
Review of one program specifically making a difference with Child Welfare clients affected by Opioid use

3. Impact on Child Protective Services
Direct Impact
Receipt of reports of infants born affected by illegal substance use
Receipt of notifications of infants born affected by legal substances that are used in a lawfully prescribed manner
Indirect Impact Receipt of reports that indirectly result from the use of substances, including Opioids

4. Direct Impact Requirements for Reporting Prenatal Neglect
If a physician has cause to believe that a newborn was exposed in utero to an unlawfully used controlled dangerous substance, as defined by R.S. 40:961 et seq., the physician shall order a toxicology test upon the newborn, without the consent of the newborn's parents or guardian, to determine whether there is evidence of prenatal neglect. If the test results are positive, the physician shall issue a report, as soon as possible, in accordance with this Article. If the test results are negative, all identifying information shall be obliterated if the record is retained, unless the parent approves the inclusion of identifying information. Positive test results shall not be admissible in a criminal prosecution.
 If there are symptoms of withdrawal in the newborn or other observable and harmful effects in his physical appearance or functioning that a physician has cause to believe are due to the chronic or severe use of alcohol by the mother during pregnancy, the physician shall issue a report.

5. DCFS Investigative Allegations of Prenatal Neglect
ALCOHOL AFFECTED NEWBORN - A newborn, age 30 days or younger, whose mother’s chronic or severe use of alcohol during pregnancy resulted in one of the following:
observable and harmful effects in the newborn’s physical appearance or functioning including a diagnosis of either Fetal Alcohol Spectrum Disorders (FASD) or Fetal Alcohol Syndrome (FAS); or,
the newborn has withdrawal symptoms or a positive alcohol screen through a blood urine, or meconium test.

6. DCFS Investigative Allegations of Prenatal Neglect
DRUG AFFECTED NEWBORN - A newborn, age 30 days or younger, who is exposed to the unlawful use of any controlled dangerous substance, or when that substance is used in a manner not lawfully prescribed that resulted in one of the following:
observable and harmful effects in the physical appearance or functioning of the newborn; or,
the newborn has withdrawal symptoms, or diagnosis of Neonatal Abstinence Syndrome, or a positive drug screen from a blood, urine, or meconium test as described in the definition above.

7. Number of Victims with a Valid Drug or Alcohol Affected Newborn Allegation
We wanted to provide an overview of current trends, to discuss the extent of the impact on infants and families, which we believe is still an underestimate of the actual numbers;
This gives a snapshot of not only how the Opioid epidemic has affected families, but other substances as well.
We are also seeing that several of the child fatalities that we investigate, the infant has been exposed to substances.

8. Valid Victims of Drug or Alcohol Affected Newborns by Region
A breakdown by region illustrates where most of the reporting of Substance Exposed Newborns are coming from. As can be seen through this data, it appears that Lafayette is doing an excellent job in screening and reporting those newborns exposed to substances.

9. Types of Drugs Reported as Contributing Factors During CY 2016
-Louisiana began capturing data on the types of substances that families were impacted by.
The chart represents each drug indicated, but an indiviudal client may be affected by multiple substances
Marijuana is the highest used substance that we are seeing in our data, followed by Methamphetamines and then Opioids

10. Number of Valid Victims Entering Foster Care
Note: #’s reflect children entering foster care within 60 days of receiving initial report.

11. Direct Impact The Opioid Epidemic
According to LDH, data reveals how Opioid abuse has become an epidemic:
Among those people who misused prescription pain relievers in the past year, more than 50% got them from friends or relatives, 40% from health care providers, and 10% from other sources(SAMHSA 2015 Natl. Survey on Drug Use and Health)
4.3 million Americans are estimated to be engaged in non-medical use of prescription opioids
According to the CDC, Louisiana ranked first in opioid prescribing in In 2016, Louisiana ranked 5th.

12. The Comprehensive Addiction and Recovery Act
As a result of the Opioid epidemic, the Comprehensive Addiction and Recovery Act (CARA) was passed in 2016.
One component CARA made changes to the Child Abuse Prevention and Treatment Act (CAPTA) and how states are responding to the crisis in relation to meeting the needs of newborns affected by this crisis;
As a result, state legislation was enacted to address the needs of newborns affected by legal substances used in a lawfully prescribed manner.

13. Direct Response to the Opioid Epidemic
Louisiana added a law, outside of the Louisiana Children’s Code, entitled “Neonatal Abstinence Syndrome”.
This law requires a Physician to notify DCFS of those newborns who exhibit withdrawal symptoms to prescribed substances that are used in a lawfully prescribed manner.
Brings Louisiana into compliance with the federal legislation (CARA and CAPTA) while also providing a comprehensive approach at addressing the needs of all newborns affected by prenatal substance exposure.

14. Physician Notification Form – Substance Exposed Newborn – No Prenatal Neglect
This notification is completed by the physician and includes demographic information as well as items to address the health and safety needs of the newborn and family;
This notification does not constitute a report of abuse/neglect and DCFS does not initiate contact with these families.

15. Service Provision for Substance Exposed Newborns
Louisiana requires that a Plan of Safe Care be developed for all newborns affected by prenatal exposure to substances. This plan is designed to address the health and safety needs of the newborn and their family;
For all newborns identified during the Child Protective Services Investigation, this Plan of Safe Care includes a referral for the newborn to Early Steps and a referral for the parent to undergo a substance abuse evaluation.
The Plan of Safe Care also includes a careful assessment of safety factors and risk, which assist in determining additional interventions;
A Plan of Safe Care continues, if needed, throughout the life of the case, including intervention by Family Services and Foster Care.
It is always the Department’s desire to prevent a child from entering foster care, when safely able to do so;

16. Collaborative Efforts in Service Provision
DCFS is collaborating with numerous stakeholders to initiate quarterly meetings to be held in each region. The goal of these meetings is to collaboratively work together to identify strengths and gaps in service provision, develop strategies to address identified gaps, and to share resources to improve the outcomes for newborns affected by prenatal substance exposure.

17. Indirect Impact Most Common Reports Received resulting from Substance Use
Lack of Supervision – Failure of the parent or caretaker to provide adequate supervision, care, guidance, and/or protection to a child while present or at close proximity. The failure to arrange for adequate care and/or supervision during his absence, places the child in situations beyond his ability to cope or at risk of physical harm or exploitation. Example: Parents leaving their children alone, incidents resulting from the lack of supervision provided while the parent’s are under the influence.
Dependency - Being without reasonable or necessary food, clothing, shelter, medical care, supervision or other care, or without parental care or guardianship, as a result of the severe mental illness, chronic physical illness or physical disability, mental retardation, death, incarceration, chemical abuse, or other condition related to the parent's ability to care for the child. Example: a parent/caretaker is too incapacitated on an ongoing basis to provide minimal care as a result of substance abuse. A parent is absent for a prolonged period of time, or neglectful as a result of chronic substance abuse.

18. Impact of Substance Exposed on Direct Field Practice

19. Working with Substance Exposed Newborns & their Families
It is the responsibility of the Department of Children & Family Services to develop and provide social services, rehabilitate persons with disabilities for employment, and improve social conditions for the citizens of Louisiana. The Department goal is to assist individuals and families in protecting their physical and emotional well being, and in meeting their basic human needs of economic self support and self-sufficiency in accordance with state and federal laws and regulations.

20. Family Dynamics
Single Parent Household
Two Parent Household

21. Dysfunction of the Family due to Substance Abuse
Financial Hardships
Housing
Employment
Legal Issues
Separation from family

22. Substance Exposed Newborns
Developmental Delays
Poor Feeding
Sensitivities
Crying
Skin tags
Medication to be weaned off substances

23. Investigations
DCFS receives a report regarding allegations of abuse or neglect
DCFS Investigator meets with the family to assess safety and risk of the household
Information gathered from collaterals (i.e. neighbors, doctors, family members, etc) to determine validity
Staffings held to determine if services needed for the family and a referral for services is made with Foster Care or Family Services Program

24. DCFS Programs Foster Care Family Services
Children remain in the home of the parent
Parent(s) have to be willing to participate
Assess family to determine strength & weakness, and make appropriate referrals based on needs
Not appropriate if safety & risk assessment determines children at risk to be harmed if they remain in the home
Children are removed from their home and placed in a foster home
Needs of the parents and children are assessed and case plan developed
Parent(s) referred to appropriate services providers to help them work toward a permanent plan
- Reunification, Adoption,
APLA, or Guardianship

25. Lafayette Family Preservation court
Substance exposed newborns
Presented By Darce’ Byrd

26. Family Dependency Court Introduction
The first problem-solving court to address child dependency issues started in Reno, NV in 1995
By 2005 there were 193 Family Dependency Courts across the U.S.
At last count there were 381 Family Dependency Courts, with more currently in development
The Family Dependency Court partnership model includes the court, child protective services and service providers for the parents, children and families.
Two types of courts FDC’s are Integrated and Parallel
There are currently 4 in the state of Louisiana, Lafayette was the pilot program in 2010.

27. Why are family dependency courts so important?
15% of infants born annually are affected by prenatal alcohol or drug exposure
2.7% of NICU admissions were for infants with Neonatal Abstinence Syndrome
45% of children who entered out-of-home care in 2015 were under age 6
The number of children under the age of 1 entering foster care is increasing and has become the highest percentage, by age group, of children entering foster care
90% of those who need treatment services for a substance use disorder do not receive them
50% of families who participate in family drug courts achieve reunification
*Statistics are from

28. High-risk population
Medicaid patient population is more likely to receive prescriptions for opioid pain medications and to have opioids prescribed at higher doses and for longer periods of time than the non-Medicaid patient population
Among women, the number of overdose deaths due to the use of prescription opioid pain medications has increased significantly since 2007, surpassing deaths from motor vehicle-related injuries.
From 1992 to 2012, treatment admissions for pregnant women among all female admissions remained stable at four percent. However, the amount of pregnant women entering treatment who reported any prescription opioid misuse increased substantially from two percent in to 28 percent in 2012, an increase from 351 to 6,087 women
NAS cases increased from 7 cases per 1,000 admissions in 2004 to 27 cases per 1,000 admissions in 2013

29. If a parent’s substance use disorder is not addressed with appropriate treatment and long-term recovery support, the infant and family may also experience ongoing challenges in safety, permanency, and well- being. The unique intersection of pregnancy and substance use creates a need for a collaborative approach bringing the expertise of many health, substance use treatment, child welfare, and early childhood providers to address the multifaceted needs of the mother, infant, and family.

30. Lafayette family Preservation court
Since 2010 LFPC has treated 154 parents
LFPC has assisted in reunifying 43 parents with their children
LFPC can currently serve 30 parents
Since January 2017 LFPC has been referred 133 parents by DCFS
47 of those parents have been referred for a substance exposed newborn
12 clients were accepted into LFPC, 3 of those clients were referred for substance exposed newborns

31. LFPC Stats
Out of those numbers, we see the following parents with substance exposed newborns:
26 out of the 54 Denied Services
7 out of 17 Primary Mental Health
10 out of the 31 Were No Shows
5 out of the 13 Were Prescribed Narcotics
5 of the 6 Had No Transportation
Out of the 121 that did not accept services through LFPC:
54 Denied Services
17 Primary Mental Health
31 No Shows
13 Prescribed Narcotics
6 No Transportation

32. Differences…
FDC’s seek to target pregnant women and parents with children between the ages of 0 and 3 years old, whose abuse of substances have placed their children at risk of out of home placement.
Gives parents earlier access to assessments to substance abuse treatment
Judicial Involvement
Engages the parent through the “team” approach
FDC strive to reduce subsequent births of babies with drug exposure.
LFPC seeks to target ALL AT RISK parents with children, whose abuse of substances have placed their children at risk of out of home placement.
Gives parents earlier access to assessments substance abuse treatment.
Judicial Involvement
Engages the parent through the “team” approach
LFPC strive to reduce subsequent births of babies with drug exposure & RE- ENTRY INTO FOSTERCARE

33. What does lfpc entail?
12 Month Track (4 Phases)
Treatment no less than once a week
Court no less than once a month
Drug screens 1-3 times a week
1-3 Recovery Activities a week
Obtain a Sponsor
Meet w/ Recovery Coach
Case Management with LFPC
Complete all components of DCFS case plan
6 Month Track (2 Phases)
Treatment no less than once a week
Court no less than once a month
Drug screens 1-2 times a week
1-3 Recovery Activities a week
Obtain a Sponsor
Meet w/ Recovery Coach
Case Management with LFPC
Complete all components of DCFS case plan
Other possible requirements: inpatient treatment, mental health treatment, parenting, job placement, GED or referral to further education, criminal charges, housing, medical referrals..etc

34. Why a team approach?
IT CANNOT BE DONE ALONE

35. Phase One Failed Drug Screens

36. Phase Two
Failed Drug Screens

37. Phase Three Failed Drug Screens

38. Phase Four Failed Drug Screens

39. Lafayette preservation court has seen
15 DRUG FREE BABIES SINCE 2010

40. Lafayette Family Preservation Court 337-456-3887 111 W. Main Street
Thank you Please feel free to contact us at
Lafayette Family Preservation Court
111 W. Main Street