Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Referral to Child Protective Services

In most jurisdictions, child welfare services are responsible for a broad array of activities including preventing unnecessary separation of children from their families, restoring children who have been removed from their natural families through provision of appropriate services, placing children in suitable adoptive homes in cases where reunification with the biological family is inappropriate, and assuring adequate care of children not living with their families.

Within the child welfare system, child protective services (CPS) is the administrative unit responsible for investigating allegations of abuse and neglect. The focus of CPS is on strengthening and empowering families who are at risk of child abuse and neglect; removing children from their homes is seen as a last resort when continued work with the family has failed.² Regarding the referral of a drug-exposed infant to child protective services, the following guidelines are offered:

1. Reasons for referral - Prenatal drug use or a positive drug test should not be an adequate reason in and of itself for referring an infant to CPS. Referral should be made only when there is some question about the health and safety of the child. However, in some States, by statute, evidence of drug exposure or a positive urine toxicology is, by itself, grounds for making a child abuse report. Therefore, although a mother's presumed drug use is not an adequate reason for an infant to be referred to protective services, referrals are sometimes made on this basis.
2. Placement decisions - The decision to remove the child from the home should be made if a child is endangered or if the parents cannot adequately provide for the child's health and welfare. Such decisions should be made only after thorough assessment of the infant's family situation. The mother's ongoing substance use, by itself, should not be a criterion for mandating removal from the home. Occasional relapse is a normal part of the recovery process and, as such, should not be the sole criterion for removing the infant from the home. By both Federal and State law, child welfare agencies must make "reasonable efforts" to prevent the removal of a child from his or her parents through the provision of services for the family, unless a child would be endangered even with the provision of such services. In some jurisdictions, the caseloads of child protective workers are so large that the goal of strengthening and empowering the family has been difficult, if not close to impossible, to achieve.
3. Placement with relatives - If the child is to be removed from the mother, the first priority should be to place the child with responsible grandparents or other family members, rather than making an immediate placement to foster care. This recommendation should be tempered by the realization that a large proportion of substance-using mothers may themselves be children of substance-using parents. Placement of an infant with grandparents or other family members who have problems with AODs is clearly inappropriate. However, where appropriate, placement of a child with family members can result in significant benefits to the child. Such a placement may be less disruptive and stressful because the child is not separated from family.
4. Special programs and funding for drug-exposed children - Because foster care systems are receiving increasing caseloads of drug-exposed children, there is a necessity to develop special training and other programs for meeting their needs. In addition, special funding should be procured to help meet the increased costs incurred by the adopting parents of drug-exposed infants. Most drug-exposed children qualify as "special needs" children. Both foster and adoptive parents may be able to receive special subsidies to help care for the child. In addition, children in foster care receive Medicaid, and Medicaid follows the child after adoption. Thus, children who were Medicaid-eligible before adoption can continue to be eligible to receive Medicaid after adoption, up to adulthood. However, it is a good idea to obtain verbal and written agreements regarding both the special needs subsidy and Medicaid eligibility before the adoption or foster placement is finalized.
5. Foster placement - Given the specialized needs of the drug-exposed infant, efforts should be made to develop special foster homes with a limited number of children placed in such homes. (Child welfare agencies often provide special foster homes and / or residential facilities with additional financial reimbursement and other support.)
   1. Family reunification - If an infant is placed in foster care, the ultimate goal should be reunification with the mother at the earliest possible time, as soon as the health and safety of the infant and mother can be assured, in the best judgement of the caseworkers. This goal should be clearly communicated to foster parents. It must also be acknowledged that reunification may not be possible or practical based on the best interests of the child.
   2. Stability - Wherever possible, serial foster care placements of any infant should be avoided. Such placements weaken an infant's ability to bond with caretakers and threaten his or her emotional, physical, cognitive, and social development, with effects often lasting into the adult years.