Substance use among parents and caregivers, particularly new parents, has been a concern to those working within the child welfare system for many years. Much has been done to support substance-exposed newborns and their families over the last twelve years; and more improvements are on the horizon thanks to multidisciplinary collaboration at the local and state levels. While only around 4% of referrals to the department in 2019 contain allegations of a substance-exposed newborn, according to the Colorado Department of Human Services, most referrals to the Colorado child welfare system related to substance use are for children younger than one month. (1)

Colorado experts in child welfare and child maltreatment prevention recently sat down with the Colorado Division of Child Welfare CAPTA and federal funding administrator Matt Holtman to talk about efforts underway to improve support for families impacted by substance use disorders prior to the birth of a new baby and those first years of a child’s life.

The panelists included:

• • • Jade Woodard, executive director of Illuminate Colorado and co-chair of the Colorado Substance Exposed Newborn Steering Committee, a subcommittee of the Colorado Substance Abuse Trend and Response Task Force;
    • Suzy Morris, substance exposed newborn specialist with the Colorado Division of Child Welfare working to oversee practice related to substance-exposed newborn and roll-out of Plans of Safe Care for the State of Colorado; and
    • Angela Mead, deputy division manager at Larimer County Human Services and project lead for Plans of Safe Care in Larimer County.

 Over the course of the hour-long town hall with county employees, progress through a variety of collaborations and tools were covered including legislative changes to the Children’s Code in 2020 as a result of SB20-028 Substance Use Disorder Recovery. This bill:

• • • de-emphasizes the focus on a test,
    • removes the references to the federal schedule of substances,
    • elevates impacts to the child as the main consideration, and
    • advances a two-generation approach to keep parents and their children together during treatment.

C.R.S. 19-1-103(1)(a)(VII) now states:

Any case in which a child IS BORN AFFECTED BY ALCOHOL OR SUBSTANCE EXPOSURE, EXCEPT WHEN TAKEN AS PRESCRIBED OR RECOMMENDED AND MONITORED BY A LICENSED HEALTH CARE PROVIDER, AND THE NEWBORN CHILD’S HEALTH OR WELFARE IS THREATENED BY SUBSTANCE USE

The purpose of this change was to:

• • • increase alignment with federal law
    • reduce the emphasis on schedule I and II controlled substances
    • increase access to the most appropriate supports by reducing stigma and fear associated with seeking treatment and ensuring more holistic and meaningful assessments are done to help understand the risk and safety considerations

“This was a big change needed to bring Colorado where we needed to be to really start to make progress on the amazing systemic work happening to increase access to substance use treatment and support families in being well, together,” said Woodard during the presentation.

Plans of Safe Care is one of the systemic shifts beginning to take hold in Colorado. Most new parents leave the hospital feeling scared and nervous about now being responsible for the safety and well-being of an infant. A substance use disorder can make this challenging time significantly more difficult for parents and caregivers. Coupled with the unique needs of substance-exposed newborns in the first days and months of life at home, it is easy to understand why special attention to this period of time can produce extraordinarily positive results for parents and their baby.

Children deserve to grow up with a family and research shows this is best for newborns and new parents. When safety concerns have been identified, caseworkers strive to help a parent address those concerns while keeping the family together. In 2019, in recognition of the unique opportunity to serve substance-exposed newborns and parents together and in response to changes in federal law, Colorado launched a Plans of Safe Care pilot to send parents and babies home from the hospital with a plan for safety.

Angela Mead and Larimer County were a part of piloting this effort. She shared her experiences collaborating closely with Poudre Valley Hospital to identify substance-exposed newborns as early as possible and partnering with families to set up systems of support.

“In my experience Plans of Safe Care is really a mechanism for engaging parents in caring for their infant and mitigating the risk of child abuse and neglect” said Mead. Reflecting on outcomes of the pilot, Mead shared that Larimer County had “seen an increase in our family engagement, there have been improvements in our discharge planning process, the hospital reports there has been a reduction in readmission for infants and there has been a reduction in length of stay at the hospital. In many of these cases, there has been a reduction of out of home placement and that is really the goal of Plans of Safe Care – maintaining the family unit and helping parents be successful in caring for their children.”

Other Important Tools for Professionals in the Child Welfare System Supporting Families Impacted by Substance Use Disorders Welcoming a New Baby

Reading toxicology results, as well as trying to decipher symptoms related to substance use, can be complicated and overwhelming. A Toxicology Resource Guide was developed to support Colorado child welfare professionals in understanding substances, possible effects and the utility and application of toxicology testing to enhance practice. Look for a short video and blog next week highlighting how this guide is an essential tool for child welfare supervisors and caseworkers!  

To aid multidisciplinary teams of Colorado professionals needed to implement Plans of Safe Care, the Department created a new section on the Colorado Department of Human Services website.

Multiple courses on substance use and families, including Prenatal Substance Exposures, are available through the Child Welfare Training System:

• • • The Substance Use Puzzle (OnlineTraining)
    • Building Safety When Parent Use Substances (1 Day)
    • Enhancing Practice with Families Impacted by Substance Use (2 Days)
    • In Depth with Substance Use & Families (ECHO Series)
    • Fetal Alcohol Spectrum Disorders (Online Training)
    • Impacts & Implications of Prenatal Substance Exposure (1 Day)
    • Plans of Safe Care (Web Based Training)
    • Legalized Marijuana: Considerations for Child Safety (OnlineTraining)
    • Marijuana, Children, & Families (1 Day)
    • Opioids & Families (ECHO Series)

WATCH THE VIDEO of the town hall for child welfare professionals to learn more about these tools, as well as:

• • • a review of the work being done through the Colorado Substance Exposed Newborn Steering Committee
    • details on the rule-making process as a result of SB20-028 Substance Use Disorder Recovery already underway
    • implementation timeline for Plans of Safe Care
    • ways to get involved to get involved in systemic changes supporting substance exposed newborns and their families

Sources

(1) Oliveros, A., & Kaufman, J. (2011). Addressing substance abuse treatment needs of parents involved with the child welfare system. Child Welfare, 90(1), 25-41.

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