6.2 “Newborn Crisis Assessments”
In these cases, a home assessment is requested by a physician or other medical personnel when they have serious reservations about releasing an infant from the hospital who may be sent home to a potentially dangerous situation. Many times a drug-involved mother may continue using drugs, so an assessment of the home situation is needed prior to, or at the time the infant is released from the hospital. There may also be other non-drug related situations in which a physician/health care provider is concerned about releasing a newborn infant from the hospital. Non-drug involved referrals will be accepted until the child is one year of age.
- If the physician/health care provider is concerned about releasing the infant from the hospital, in the case of a drug-involved infant, and needs an assessment of the home before DHSS becomes involved (as it will be 72 hours before DHSS makes initial contact), they may request assistance from CD. The request for a “Newborn Crisis Assessment” may be received by the Child Abuse/Neglect Unit or county office staff, and may be made prior to, or at the time of, the infant’s release from the hospital. If there is an open family-centered services or out-of-home care case, the county may elect to have the assigned worker complete the assessment rather than an investigative worker.
- Although this will not be a child abuse/neglect report, county staff will handle the referral as an emergency, requiring the worker to assure the child’s immediate safety. Depending on the situation assuring safety may require immediate face to face contact or may consist of phone contact with the reporter or hospital to confirm the child is safe and to discuss the plan for discharge. The assessment should include a recommendation as to whether the infant should be released from the hospital with the mother.
- If the worker feels the child should not be released with the mother, a referral to the juvenile court would be in order. The feedback will be provided by telephone or in person. Newborn Crisis Assessments should be documented using the NCAT, Newborn Crisis Assessment Tool (or comparable assessment tool approved by Central Office), as well as the CPS-1A Safety Assessment (Part B).
6.2.1 The Newborn Crisis Assessment, at a minimum, Shall Include:
- Contact with physician or health care provider who made the referral to gather information on: delivery complications, signs and symptoms of exposure at birth OR mother/infant toxicology (obtain written medical documentation of the signs or symptoms of exposure at birth or toxicology test results), mother/infant behavior while hospitalized, and other concerns;
- Visit with the mother at the hospital, if still hospitalized, or in her home to assess plans and abilities for caring for the infant upon release. The following should be determined while interviewing the mother:
- prenatal care;
- pregnancy complications (i.e., premature labor);
- physical, emotional, intellectual functioning;
- observation of attachment and bonding with the infant;
- parenting skills (infant and other children);
- planning for birth/hospital discharge (i.e., infant’s baby supplies, crib, bottles, formula);
- behavior associated with alcohol/drug use;
- self identifying problems associated with alcohol/drug use; and
- criminal history;
- Observation of the infant. Note: If a mother and infant are in the hospital in another county, staff may request a courtesy assist from CD staff in that county to visit the hospital and provide information to the county of residence. Observation of the infant should include:
- Signs of withdrawal
- Medical complications (NICU)
- Special health care needs (home health care recommended by Doctor)
- Visit to the mother’s home, and/or home the infant will go upon hospital discharge to assess the following:
- Children, if any, in the home (i.e., school attendance, prior juvenile office involvement);
- Support systems in place, which may include family, friends, or other agencies involved. Staff may use genogram and ecomap in CD-14 to gather information;
- Presence of supplies for infant’s arrival (i.e., crib, clothes, bottles);
- Condition of the home;
- Observation/names of individuals residing in the home; and
- Domestic relations (i.e., father or parent substitute is supportive)
- Contact with all children, if any, in the home within 72 hours to assure safety.
- Contact with other adults/children in the home to assess the following:
- Verification of readiness for infant’s arrival;
- Expression of concern regarding mother’s alcohol/drug use;
- Other household member’s description of available support; and
- School attendance of other children in the home.
- Contact with other agencies involved with the family to determine and coordinate support, if appropriate;
- Contact with Juvenile Court if it is determined the infant will be subjected to further drug exposure, or neglect if he/she remains in the mother’s custody; and
- Summary of strengths/concerns and recommendations regarding CD case opening determination, as well as, placement plans for the infant.
- Generate a child abuse/neglect report if abuse or neglect of another child in the home is observed or suspected.
- Provide information to the referring physician/health service provider, in person or by telephone. The information provided will include a recommendation as to whether the infant should be released from the hospital with the mother. If the worker feels the infant should not be released with the mother, the worker will make a referral to the juvenile office.
- Document on the newborn crisis assessment tool and the CPS-1A the information provided. If the division becomes involved with the family, or there is currently an open file, combine this information with the case record.
- For all drug-involved newborn crisis assessment referrals, contact DHSS/SHCN if the physician has not already done so, by referring directly to the local SHCN Service Coordination Regional Office. Upon notification of acceptance from or request for additional information, provide the following documents:
- Medical documentation of signs and symptoms consistent with controlled substances or alcohol exposure in the infant (up to 28 days of age, according to DHSS’s perinatal definition) at birth; OR
- Confirmed positive toxicology test for controlled substances performed at birth on the mother and/or child; AND
- Written assessment and recommendations.
NOTE: If CD is opening a case based on the assessment, the SHCN referral must include a statement that the infant is at risk of child abuse/neglect for the referral to be complete.