DSS Policy and Procedure Guide
Division 3: Child Welfare
Chapter 3: Initial Response/Detention
Item 4: Drug Exposed Infant Protocol
Suggested changes send to: DSS PSOA Mailbox
Issued: 10-28-2011
References: Senate Bill 2669 (Presley Bill);
California DSS Division 31-135; Welfare &
Institutions Code 305; Penal Code 11165.13
Replaces Issue: November 7, 2007
Policy
Reports about drug exposed infants shall be investigated by Department of Social Services’ Child
Welfare Emergency Response social workers (Child Protective Services). Additionally, the parents
and their home will be assessed regarding their housing, family support system, resources and their
ability to parent other children in the home. Reports about the mother or newborn testing positive
for illegal drugs or alcohol, the mother’s self-report of drug or alcohol abuse during the pregnancy,
or a medical diagnosis indicating abuse of drugs or alcohol during the pregnancy will be identified as
“Drug Exposed Infant (DEI) referrals.”
NOTE: While the mother’s self-report of drug or alcohol abuse is a concern, it is not in it of itself
enough to place a department Hospital Hold.
Purpose
To inform Department of Social Services (DSS) Social Work staff of roles, responsibilities, and
general requirements for reports, referrals and assessment of drug exposed infants.
Introduction
Pursuant to SB 2669 and Penal Code 11165.13, substance abuse, in and of itself, has been identified
as a health issue and not automatically a CPS issue. However, the birth of drug exposed infants will
be reported to CPS when hospital staff has identified additional concerns including, but not limited
to the following:
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The physical and emotional stability of the parents;
The parents’ ability to care for the infant as demonstrated by history with other children;
The mother’s bonding and interaction with the infant;
The parents’ preparedness for the infant as evidenced by the presence of adequate baby supplies.
Procedure
Initiating the CPS Referral
When a telephone referral comes into the Child Abuse Hotline on a drug exposed infant, as much of
the following information as possible should be gathered from the reporting party:
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 Identity of reporting party including name, job title, hospital name and telephone number.
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Parent(s) and infant’s name, names of siblings, birth dates, addresses and primary language of
the family, if known.
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Medical status including the infant’s birth weight, gestational period, any withdrawal symptoms
or medical problems. Toxicological screen results, including drugs tested for, and discharge
dates for mother and infant.
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Medical history should include prenatal care for mother, any history of Sudden Infant Death
Syndrome, and history of previous drug exposed pregnancies.
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Special Observations:
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Any known history of drug use by either parent, as well as mother’s admission or denial of
drug use, and any known or reported previous drug treatment and her compliance with those
programs.
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Mother’s observed interactions with the infant and any other children.
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Father’s observed interactions with the infant and any other children.
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Parents living situation, which includes the physical environment of their home as well as
any preparations she has made for the infant.
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Parents’ cooperation in addressing problems with medical staff, her psychiatric history (if any)
and her current functioning.
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Identified support systems for family.
Creating a new referral in CWS/CMS
The information reported will be documented in a new referral created in CWS/CMS with an
allegation of General Neglect.
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Consistent with definitions from Structured Decision Making (SDM), a “drug exposed infant”
will be defined as follows:
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Mother and/or baby has a positive toxicology screen at birth; OR
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There was pre-natal substance abuse exposure as evidenced by pre-natal test or mother’s
self-admission; OR
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There is a medical diagnosis of a condition(s) present for the mother or newborn indicative of
alcohol or drug abuse.
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For the purposes of this protocol, “drug exposed” and “substance abuse” will include alcohol.
Referrals meeting the definitions above will be identified as “DEI referrals”. The social worker
shall respond according to the SDM response time tree.
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PPG 3-3-4
Assessment By A Social Worker
The assigned social worker will assess the risk to the drug exposed infant and the family’s need for
services. This will include obtaining any relevant additional information that was not obtained from
the reporting party.
The SW shall take the following actions:
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Review any available records and history of prior CPS involvement with the parents and other
adults known to reside in the home or anticipated to be secondary caregivers.
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Contact the following collateral people:
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The reporting party to provide the name of the responding social worker, a response time
frame, and any other history the reporting party may have discovered since making the
original referral.
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Hospital staff to obtain information regarding the infant’s current and on-going medical
needs and the infant’s prognosis.
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Any other collateral people involved with the family, including the public health nurse,
drug counselors, therapists, and teachers.
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Obtain identifying information about the infant’s father or individuals alleged to be the father.
Ask hospital staff if a Declaration of Paternity has been signed.
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Conduct a criminal record check on the parent(s) and other adults in the home.
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Conduct a face-to-face interview with the mother, the infant’s father, the mother’s partner if
other than the infant’s father, and other available family members, if available.
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Obtain documentation from the hospital from both the mother’s and infant’s patient records
including:
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Toxicology results;
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The infant’s birth weight, length of gestation, Apgar scores, physical condition, medical
needs;
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Hospital staff’s observations of parent-infant interaction and parents’ statements to hospital
staff relevant to the assessment of the parents’ ability to properly care for the child, and
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Narratives from the hospital’s social worker, nursing/progress notes, and any statements or
reports from doctors relevant to the assessment.
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Complete a home call to assess the housing, family support system, and resources. The social
worker will assess the mother’s preparation for the infant, availability of food, total home
environment, and the financial means of support for the infant
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Assess the parents’ ability to parent the infant and any other children in the home.
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With the above information, the social worker shall:
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Determine the degree of risk to the infant.
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Complete the Structured Decision Making (SDM) Safety Assessment and, if the allegation has
been determined to be inconclusive or substantiated, the SDM Risk Assessment shall also be
completed. The SW shall use these tools when making subsequent decisions.
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Analyze the nature of the problem(s) placing the infant at risk and determine the possible causes.
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Identify the services which might remedy the problem(s).
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Ensure that the family understands the nature of the services offered and why they are being
offered.
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Determine the degree of intervention necessary to protect the infant. The social worker must
determine if a protective hold is necessary or if, with services, the infant can be safely
maintained in the parents’ home.
The Following Factors Shall be Considered When Deciding Whether a Protective Hold is Necessary:

The infant has a positive toxicology screening result, is in clinical withdrawal, has been
diagnosed as having Fetal Alcohol Syndrome, or has special health care needs.
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Mother admits to, or is exhibiting behavior suggestive of, current drug usage including positive
urine tests.
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Mother shows limited attachment to infant, exhibits minimal bonding behavior, or has problems
taking care of the infant while in the hospital.
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Mother had no prenatal care and the parents have made no preparations for the infant such as
adequate housing and appropriate infant items.
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There is CPS history and older siblings are, or have been, in out-of-home care.
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Previous CPS involvement has not ameliorated the family’s problems.
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Lack of family support system that can assist the parent(s).
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Mother denies drug usage and has not involved herself in drug rehabilitation, or there is poor
compliance (i.e. dirty tests).
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Mother is involved with a drug-sharing partner and drug culture.
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History of parental drug related criminal arrests and convictions.
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Parent(s) refuse medical follow-up services for the infant, or case management services, if
recommended.
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If a positive urine test is not received on the mother or child, law enforcement must be notified
for a joint assessment of whether to take the child into temporary custody (a protective hold per
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PPG 3-3-4
W&I Code 305). If the law enforcement assessment concludes that a protective hold is not
warranted and the SW still assesses risk to the child, a Protective Custody Warrant shall be
requested in Juvenile Court.
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The process for a TDM/Staffing shall be followed.
If the Social Worker Assessment Indicates a Protective Hold is Likely to be Needed and the Infant is
Still Hospitalized, the Social Worker shall:
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Be certain that all necessary documentation has been obtained.
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Be certain the Protective Hold on Hospitalized Minor form (6154) is completed and law
enforcement signs the form and notes law enforcement report number.
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Advise hospital staff to note in both the mother’s and infant’s patient records that “the CPS
investigation is still in progress” and that CPS (Child Protective Services) should be notified
immediately when the infant is ready to be released or if a parent threatens or attempts to remove
the child from the hospital against medical advice. The Child Protection Hotline phone number
shall be provided to hospital staff.
Note: The SW shall not instruct the hospital that a hold will be placed or that they cannot
release the child to a parent, and shall not restrict the parents from visiting with the child at this
time. Such statements could legally constitute a Protective Hold.
Note: If safety concerns exist, and they do not rise to a level of immediate removal of the infant, an
Imminent Risk TDM shall be held.
When the Infant’s Discharge is Imminent and the Decision is Made that a Protective Hold and Outof-Home Placement are Needed, the Social Worker Must:
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Verify again that all necessary documentation has been obtained.
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DSS staff shall submit Form 6028, “Initial Request for Placement,” to request a foster home that
can meet the infant’s needs. Standby staff will locate a placement for the infant and shall follow
forms procedures outlined in PPG 3-3-10.
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Complete all fields on the Protective Hold on Hospitalized Minor form (6154). Provide copies
for both the mother's and infant’s patient records. The original is retained for the CPS case
record.
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Assure that the infant is moved from the mother’s hospital room to the nursery. Subsequent
contact between the parent(s) and the infant should be allowed or restricted based upon the safety
concerns on a case-by-case basis. The social worker shall consult with a supervisor about any
restrictions.
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Be present at discharge or at least actively involved in the discharge planning to facilitate out-ofhome placement.
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If the infant is discharged and placed by Standby staff, the following actions are to be completed
by the assigned social worker:
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 Follow policies and procedures for Protective Holds including arranging for a Team Decision
Making (TDM) meeting, completing the foster care eligibility packet, and arranging for the
Child Packet (JV-225 Child’s Health and Education form, Parental Notification of Indian
Status) to be completed as soon as possible.
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The decision regarding a dependency petition will be made at a TDM.
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A TDM shall be held for all placement decisions including the following circumstances:
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Parents are absent, incarcerated, or refuse to participate in a TDM or any services
recommended, or
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It is likely that reunification services will not be provided, pursuant to Welfare and Institution
Code section 361.5(b)
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If the infant has already been discharged from the hospital at the time a decision is made to
place the infant in protective custody, standard DSS procedures for placing a Protective Hold
should be followed.
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