Infant/Child Overdose Deaths Expert Article

Over the past decade, infant and child deaths related to synthetic opioids, mainly fentanyl, have been on the rise. Many times, these children are either active with child welfare at the time of their death or have had previous contact with local child welfare agencies prior to their deaths.

In this article, social work expert Abigail Rich explores the role of child welfare agencies in creating and implementing a Plan of Safe Care for children born exposed to drugs and alcohol along with investigating and providing child welfare services to young children living with parents documented as substance abusers.

Infant/Child Overdose Deaths & the Role of Social Services

Children of all ages, but particularly young children, who are living with adults that are actively using drugs and alcohol are at risk of accidental overdose.

These overdose incidents often occur when drugs are left within a child’s reach, unintentionally, or the residue of a substance gets on a child’s bottle or some other item that the child puts in their mouth.

At times, a parent may awake, after using drugs, to find their young child has died because they ingested the substance while the parent was asleep or unconscious.

Child Welfare Intervention

For children of parents suffering from drug addiction, there are several benchmarks when intervention by child welfare services can save that child’s life.

The very first required intervention is when an infant is born with or identified as affected by prenatal substance abuse exposure, including experiencing withdrawal symptoms from drugs, alcohol or prescription medications. At this early period, health care providers are required by law to make a report to Child Protective Services.

In 2003, The Child Abuse Prevention and Treatment Act (CAPTA) first introduced the Plan of Safe Care (POSC) which became a legal mandate in 2016, when the Comprehensive Addiction and Recovery Act (CARA) amended CAPTA. This amendment requires that all states operate a statewide program that includes developing a Plan of Safe Care for the infant who has been affected by prenatal substance exposure.

The purpose of the POSC is to ensure the safety, health and well-being of these infants, first and foremost. Considering the overall safety and well-being of the child, the POSC is meant to be a family-centered plan that is created by the parent, their family and care providers, including social services, that identifies the strengths, needs and services necessary for the parent using substances.

The POSC also includes an assessment of the infant and family to identify immediate safety risk and health needs. It identifies services for the infant which may include:

• Medical care
• Developmental support such as early intervention evaluations and services
• Monitoring of withdraw symptoms:
  • Irritability, tremors, sleep disturbances, poor feeding, seizures

The plan also identifies services for the parents which may include:

• Substance abuse treatment (inpatient or outpatient) and drug screen monitoring
• Mental health support (individual therapy, group therapy, medication management)
  • Parenting resources:
  • Parenting classes,
  • Physical items (as needed) ex: car seat, pack-n-play, crib, etc.
  • Connection to community services such as WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)
• Housing referrals
• Transportation assistance

Monitoring and follow-up by the child welfare agency to ensure the plan is implemented effectively by all parties and adjusted as needed is a crucial, ongoing element of the Plan of Safe Care.

Monitoring and Documentation

It is imperative for child welfare personnel and other professionals involved in developing and implementing the Plan of Safe Care, to monitor, assess and document the services provided to the family on an ongoing basis. This documentation, typically found in case notes, also includes any and all progress made towards established goals.

It is also necessary for providers to communicate with each other on a regular basis and document that communication throughout the case file, to ensure the safety of the infant, and possibly other young children in the home.

When a child welfare agency is involved in a family whose children remain at home with a parent(s) with a recent history of substance abuse addiction, it is important for the children to receive on-going monitoring of the identified services in their home.

Agency workers must monitor parental compliance to substance abuse treatment and obtain drug screen results regularly. Agency workers also want to ensure the living conditions for the children are safe, they are attending school (if school aged), being appropriately supervised and attending all medical appointments as scheduled.

Intervention for Children Substance Exposed

Child welfare intervention is required when a parent is unable or unwilling to stop using drugs. The agency worker is obligated to ensure the safety of the child, even if that means finding alternative living arrangements for the children.

If a child is removed from a parent’s custody, the child welfare agency will ensure the parent(s) has successfully completed the identified treatment through communication with the treatment provider, observation, meeting with the parent(s), and by obtaining documentation of their treatment and its completion.   

Prior to reunification, the parent(s) must be in active recovery and demonstrate evidence as such through drug screens. Once the children are reunified, supportive services must be placed in the home to monitor the safety of the children. This includes ongoing drug screens of the parents.

Throughout the intervention period, the Child Welfare agency will continue to monitor child safety to ensure the parent(s) attend all medical and mental health appointments and the children are attending school regularly.  Child welfare is required to continue to ensure the child’s safety in their home, from the time they are reunified with the parent through successful case closure.

Investigating Child Overdose Deaths

When a young child who was known by their local child welfare agency dies due to a fatal overdose, a civil lawsuit often follows.

When assessing liability, the local child welfare agency as well as other agencies contracted to provide in-home services are often investigated. Depending on the specific facts of the case, other parties may be added to the lawsuit. For example: medical providers, if it is alleged they failed to report a substance-exposed infant.

An expert investigation will typically involve a review of the child welfare agency policies and procedures as well as all applicable state and/or federal guidelines.

It is imperative to review the agency’s case file on the family to determine if the agency workers and all parties involved complied with policies, procedures and standards.

Some of the areas to explore during the investigation are:

• Was the child visited in the home on a regular basis according to policy and were those visits documented?
• Was the child’s safety regularly assessed and documented?
• Did the agency worker obtain documentation confirming the parent’s and child’s attendance at mandated appointments and school?
• Did the agency worker complete a service plan with the family so that the family was aware of the goals they needed to accomplish to be successfully discharged?
• Did the parent(s) receive regular drug screens and were the results documented?
• If the agency worker had concerns for the child’s safety or the parent(s) were not compliant with their goals, did the agency worker consult with their supervisor and was the supervisor’s actions appropriate?
• Was the agency worker receiving regularly documented supervision?

Child Welfare Expert Witness Investigations

Robson Forensic offers a comprehensive technical solution toward the resolution of disputes involving the adequacy of care and supervision of children at a broad range of public, private and institutional settings. Among our experts you can find technical experts with professional experience as licensed clinical social workers; administrators of healthcare and supervision facilities; teachers and school administrators; and psychologists.

For more information, call us at 800.813.6736 or submit an inquiry. 

Featured Expert

Abigail Rich, LCSW

Social Work Expert

Abigail Rich is a Licensed Clinical Social Worker with more than 20 years of post Masters experience. Abigail has experience as both a direct care Social Worker and Supervisor. She has worked in… read more.