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Title:

Child Welfare Manual

Section 2:

Intake

Chapter 6:

Newborn Crisis Assessment

Subsection 2:

Newborn Crisis Assessments

Effective Date:

January 2, 2013

§2 ch6: Newborn Crisis Assessment

• 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, father or other familial caretaker 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 Department of Health and Senior Services (DHSS) becomes involved (as it may be seventy-two (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 case or family-centered 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, father or other familial caretaker.
  • If the worker feels the child should not be released with the mother, father or other familial caretaker a referral to the juvenile court should be made. Newborn Crisis Assessments should be documented using the Newborn Crisis Assessment Tool (NCAT), as well as the CD-17, and CD-18 (if required).

  Related Subject: Section 2, Chapter 9.2, Assessment of Safety

  • 6.2.1  The Newborn Crisis Assessment, at a minimum, shall Include:

    1. Contact with the 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
       • father/infant behavior while hospitalized
       • other caretaker/infant behavior while hospitalized
       • other concerns noted by the physician or health care provider which include:
         • threats of danger to the infant
         • the child's specific vulnerabilities
         • the parent/caretaker's protective capacities
    2. Completion of face to face visits with the mother, father and/or other identified caretakers at the hospital, if the child is still hospitalized and in their home(s) if they are no longer hospitalized. Staff should assess the plans and abilities each parent/caretaker has with regard to caring for the infant upon release. Staff should complete home visits in every home the infant is going to reside and/or spend a significant amount of time, including the home of the mother, father and/or other familial caretakers. The following should be determined while interviewing the mother, father and/or other familial caretakers involved with the direct care of the infant:
       • 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
       • criminal history
    3. Provision of the Description of the Newborn Crisis Assessment, CS-24B at the time of initial face to face contact with the mother, father and/or other familial caretaker. Staff should take time to answer any questions they may have about the process before proceeding.
    4. Observation of the infant. (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, such as those requiring treatment in a Neonatal Intensive Care Unit (NICU)
       • Special health care needs (include home health care if recommended by a Doctor)
    5. Completion of home visits to the home of the mother, father, and any other familial caretaker with whom the infant is reported to reside and/or spend a significant amount of time with 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
       • Domestic relations (i.e., father or parent substitute is supportive)
    6. Contact with all children, if any, in the home within seventy-two (72) hours to assure safety.
    7. 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
       • School attendance of other children in the home
    8. Contact with other agencies involved with the family to determine and coordinate support, if appropriate;
    9. Contact with the 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
    10. Document on the Newborn Crisis Assessment Tool (NCAT), CD-17,  and CD-18 (if required), the information provided. If CD becomes involved with the family, or there is currently an open file, combine this information with the case record.
    11. Summarize documentation of strengths/concerns and recommendations, which include:
        • Family Centered Service/Family Centered Out-of-Home Care case opening determination
        • Placement/residence plans for the infant
    12. The generation of a child abuse/neglect report if abuse or neglect of another child in the home is observed or suspected.
    13. The provision of 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, father and/or other familial caretaker, the worker should make a referral to the juvenile office.
    14. 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 at birth (up to 28 days of age, according to DHSS’s perinatal definition)
        • Confirmed positive toxicology test for controlled substances performed at birth on the mother and/or child
        • Written assessment and recommendations.

        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.

Chapter Memoranda History: (prior to 1/31/07)

• CD06-34;

Memoranda History:

• CD11-44,
• CD11-86,
• CD13-01