Section 1, Chapter 5 (Understanding and Assessing Child Safety)

To help assess whether any child is likely to be in imminent danger of serious harm, which requires a protective intervention; and
To determine what interventions should be initiated or maintained to provide appropriate protection.

Safety is paramount: As the Children’s Division continues to work with the family, child safety remains the primary focus.

Safety is ongoing: Safety assessment and intervention begins with initial family contact and continues throughout the life of the case.

Seeks to be least intrusive: The Children’s Division strives to intervene to protect children in ways that produce the least interference with family unity, while assuring the child is safe. The most intrusive intervention would be to remove a child from the household. The least intrusive safety interventions are actions to keep the child in the home and would consist of the family’s own resources within the family’s own safety network. Staff should utilize the least intrusive interventions that will manage the safety threat.

5.2 Safety versus Risk

It is important to keep in mind the difference between safety and risk when completing this assessment. Safety assessment differs from risk assessment in that the safety assessment assesses the imminent danger of serious harm to the child and the interventions needed to protect the child. In contrast, risk assessment looks at the likelihood of any future system involvement related to abuse or neglect concerns.

The primary concern of the Children’s Division is always child safety. Whether the Division is responding to threats to child safety that are actively occurring or likely to become active, or whether resources are focused on families with a high probability the child will be maltreated in the future (risk), the focus is on keeping children safe.

Safe: A child can be considered safe when there are no threats to child safety within their caregiver’s household or when the caregiver’s protective capacities and safety network are sufficient to manage or control the threats.

Unsafe: A child is unsafe when a child is vulnerable to an identified safety threat within their caregiver’s household and when the caregiver’s protective capacities and safety network are insufficient to manage the threat to child safety.

Risk: Risk is the likelihood or probability child abuse or neglect will occur or reoccur in the future.

A decision that a child is unsafe does not necessitate removal. A decision that a child is unsafe simply informs that one of three (3) things is needed to protect the child from the safety threat(s):

An Immediate Safety Intervention Plan (CD-263);
A Temporary Alternative Placement Agreement (TAPA); or
A Referral to the Juvenile Officer for protective custody.

5.3 Components of Assessing Safety

Assessing Safety refers to all the actions and decisions required throughout the life of a case to:

Ensure that a child is protected;
Make efforts to support and facilitate the child’s caregiver and safety network in taking responsibility for the child’s protection; and,
Ensure a safe, permanent home for the child.

Assessing Safety consists of identifying and assessing safety threats, building safety networks, and creating and monitoring safety plans that enhance the capacity of caregivers and safety network to provide protection for their children.

When assessing whether a child is safe or unsafe, the practitioner must assess the following:

Is there a threat to the child’s safety?
Is the child(ren) vulnerable to the threat?
Does the caregiver have sufficient protective capacities to protect the child(ren) from the threat?

5.3.1 Safety Threats

Safety threats refers to specific situations or behaviors, emotions, motives, perceptions, or capacities of a family member that is out of control, imminent, and likely to have a negative impact on a vulnerable child. Practitioners should always be alert to safety threats at the time of initial contact and at the time of any contact with the family.

Potential threats to child safety exist in virtually every household, but generally caregivers have the protective capacity and safety network to control or manage them. A child becomes unsafe when they are vulnerable to that threat and their caregiver’s protective capacity is insufficient to protect them from the threat.

A safety threat is an immediate, significant, and clearly observable threat to a child that is presently occurring or likely to occur, which could result in severe harm without intervention.

- An immediate response is needed to control the threat.
- The caregiver may be a direct danger to the child or may be unable to protect the child from the threat.
- May involve:

- - physical aggression;
  - failure to protect the child from aggression or a dangerous situation;
  - neglectful behavior which deprives a child of essential, immediate safeguards, and/or basic necessities.

Structured Decision Making (SDM) Safety Threats

1. Caregiver caused serious physical harm to the child or made a plausible threat to cause serious physical harm in the current investigation.

Serious injury or abuse to the child other than accidental:

The caregiver caused or could have caused a serious injury, defined as brain damage, skull or bone fracture, subdural hemorrhage or hematoma, dislocations, sprains, internal injuries, poisoning, burns, scalds, or severe cuts; and the child requires medical treatment.

Threat to cause harm or retaliate against the child:

Caregiver has made a credible and believable threat that, if carried out, would result in serious harm; or caregiver plans to retaliate against child for CPS investigation.

Excessive discipline or physical force:

The caregiver used physical methods to discipline a child that resulted or could easily result in serious injury, OR caregiver injured or nearly injured a child by using physical force for reasons other than discipline. For example:

- - Child was made to do extreme physical exercises as a punishment beyond what should be expected for their age and developmental status; or
  - Caregiver has forced child to ingest food or object that could cause damage.

Drug-/alcohol-exposed infant during pregnancy:

There is evidence that the birthing parent used alcohol or other drugs during pregnancy AND this has created imminent danger to the infant. Select for a child who tests positive for substances at birth only if the safety threat will continue to be present once the child leaves the care of medical providers.

If selecting “safe with plan” and this safety threat involves a substance-exposed infant, also include a Plan for Safe Care.

1. Child sexual abuse is suspected, AND current circumstances suggest that the child may be in imminent danger.

Sexual abuse:

Suspicion of sexual abuse may be based on indicators such as the following:

- - The child verbally discloses sexual abuse
  - The child displays behaviors that strongly indicate sexual abuse (e.g., excessive, age-inappropriate sexualized behavior toward self or others).
  - Medical findings are consistent with sexual abuse.

Sexual trafficking

Sexual trafficking is the recruitment, harboring, transportation, provision, or obtaining of a child for the purpose of sex. Examples include the following:

- - Child exchanges sex for food, a place to stay, clothing, or anything the child needs or wants.
  - Person exchanges anything for a child to engage in a sex act.
  - Child makes money or is required to earn a quota for a “boyfriend,” “pimp,” ”controller,” ”manager,” or ”daddy.”
  - Person posts sexually explicit pictures of the child on the internet (e.g., Backpage, Craigslist) for the purpose of making money.

1. Caregiver does not meet the child’s immediate and basic needs for supervision, food, or clothing.

The caregiver is unwilling or unable to meet the child’s immediate or basic needs (based on the child’s age and developmental status) in one or more of the following areas, AND this causes the child to be in imminent danger.

Note: Do not score these items if the primary cause of the caregiver’s inability to meet these needs is poverty and the caregiver is willing to address these problems with caseworker and provider assistance.

Supervision

The caregiver does not attend to the child’s care and oversight to the extent that the child’s need for care goes unnoticed or unmet. Examples include, but are not limited to, the following:

- - Caregiver allows the child to play with dangerous objects, play on an unprotected window ledge, or be exposed to other serious hazards.
  - The caregiver is unavailable (e.g., incarceration, hospitalization, abandonment, whereabouts unknown) and there are no arrangements that would ensure the child’s safety.

Food

The child’s nutritional needs are not met (food or hydration), resulting in danger to the child’s health and/or safety.

Clothing

The child is without clothing appropriate for the weather and conditions, resulting in danger to the child’s health and/or safety.

1. Caregiver does not meet the child’s immediate needs for medical or mental health care.

The caregiver does not seek urgently needed treatment for the child’s medical, dental, or mental health needs or does not follow prescribed treatment for such conditions, resulting in declining child health status and imminent danger.

Note: The pursuit of traditional or alternative practices rather than prescribed treatment is included here only if there is evidence that the child’s health status is declining AND there is evidence that prescribed treatment likely would be effective.

1. Caregiver’s current substance abuse impairs their ability to supervise, protect, or create a safe environment for the child AND the child has been harmed or is likely to be harmed without intervention.

The caregiver’s current substance abuse is impacting their ability to supervise, protect, or care for the child to the extent that the child has been or injured or harmed OR is likely to be injured or harmed. Examples include the following:

- - Co-sleeping with an infant or young child while under the influence of alcohol or other substances.
  - Driving under the influence of alcohol or other substances with a child in the car.
  - Being unable to provide immediate care and/or supervision to a child in the event of an emergency or other essential need while under the influence of alcohol or other substances.
  - There is drug production/paraphernalia in the home that are immediately accessible by the child. Consider child’s age and stage, physical proximity of the substances, and child’s daily routine to determine whether substances are immediately accessible.

1. Caregiver’s current mental health, developmental status, or intellectual disability impairs their ability to supervise, protect or care for the child AND the child has been harmed or is likely to be harmed without intervention.

Caregiver appears to have behavioral manifestations of a mental health condition, is developmentally delayed, or has an intellectual disability AND this seriously impedes caregiver’s ability to supervise, protect, or care for the child. Examples include the following:

- - The caregiver’s refusal to take medication as prescribed seriously impedes the caregiver’s ability to supervise, protect, or care for the child.
  - The caregiver’s inability to control their own emotions impedes the caregiver’s ability to care for the child.
  - Due to cognitive delay, the caregiver lacks knowledge related to basic parenting skills, such as not having knowledge:
    - That infants need regular feedings;
    - About how to access and obtain basic or emergency medical care;
    - About proper diet; or
    - About adequate supervision.

1. Domestic violence exists in the household and poses an imminent danger of physical and/or emotional harm to the child.

Evidence exists of domestic violence in the household, AND the alleged perpetrator’s behavior creates a danger for the child.

Domestic violence perpetrators are caregivers who engage in a pattern of coercive control against one or more intimate partners. This pattern of behaviors may include physical or emotional harm or financial control. The pattern may continue after the end of the relationship or when the individuals involved no longer live together. The alleged perpetrator’s actions often directly involve, target, and impact and undermine protective caregivers and children in the household.

NOTE: Do not include arguments that do not escalate beyond verbal encounters and are not otherwise characterized by threatening or controlling behaviors. Do not include violence between any adult household member and a minor child.

1. The physical living conditions are hazardous and immediately threatening to the child’s health and/or safety.

Based on the child’s age and developmental status, the child’s physical living conditions are hazardous and causing imminent danger to the child. This may include situations where significant structural dangers exist in home (e.g., leaking gas from stove or heating unit, lack of water or utilities, exposed and accessible electrical wires), and no alternative or safe provisions have been made; OR serious illness or significant injury has occurred due to the living conditions, and these conditions still exist (e.g., repeated insect and rodent bites, ongoing presence of animal feces).

1. Caregiver acts toward the child in negative ways that cause severe psychological/emotional harm to the child.

Caregiver actions cause significant and excessive emotional distress for the child, leaving the child a danger to themself or others. Caregiver actions can include but are not limited to:

- - Regularly describes child in a demeaning or degrading manner;
  - Scapegoats (blames) one particular child in the family for a series of family problems; or
  - Places the child in the middle of a custody battle in ways that the child struggles to cope with developmentally.

Examples of the emotional distress the child exhibits as a direct result of the above include the following, but not limited to:

- - The child begins to self-harm (e.g., cutting, mutilating) or attempts suicide in some way.
  - The child begins to act out aggressively and seriously physically harm others. (The child may bully, demean, and degrade others as well.)
  - The child begins to significantly isolate themself from family, friends, school, and/or community providers.

1. Caregiver is unable OR unwilling to protect the child from serious harm or threatened harm by others.

The caregiver is not able to protect the child from serious harm or threatened harm from others; AND, as a result, the child is in imminent danger of physical abuse, neglect, sexual abuse, or sexual exploitation by someone with access to the child. Examples include but are not limited to the following:

- - An individual with known violent criminal behavior or sexual abuse history resides in the home or has access to the child(ren), AND caregiver has no clear plan to keep the child safe.
  - The caregiver regularly takes the child to dangerous locations where drugs are manufactured or regularly administered (e.g., meth labs or drug houses) or to locations used for sex trafficking or pornography AND has no clear plan to keep the child safe.

Note: In situations where domestic violence is present and the perpetrator’s actions and/or behavior has a direct effect on the protective caregiver’s ability to provide the child with basic care and protection, select the domestic violence safety threat rather than this item.

1. Caregiver’s explanation for a child’s injury is questionable or inconsistent with the type of injury AND the nature of the injury suggests that the child’s safety may be of immediate concern.

Child has an injury, AND caregiver’s description of events does not match the injury, AND there is reason to believe this could lead to imminent danger to the child.

Examples of a questionable explanation for a child’s injury include the following:

- - Medical assessment of an injury indicates that the injury is likely the result of abuse or is inconsistent with the explanation provided by the caregiver.
  - There was a suspicious injury that did not require medical treatment but was located anywhere on an infant (age 1 year or younger).
  - There was a suspicious injury that did not require medical treatment for a child age 1 or older but was located on the torso, face, or head; appeared to be caused by an object; or was one of multiple injuries in different stages of healing.

Examples of a caregiver’s description of events that does not match the injury include the following:

- - The caregiver denies abuse or attributes injury to accidental causes.
  - The caregiver’s explanation or lack of explanation for the observed injury is inconsistent with the type of injury.
  - The caregiver’s description of the injury or cause of the injury minimizes the extent of harm to the child.

1. The family refuses to allow the Children’s Division to assess the child, and child safety cannot be determined any other way.

This safety threat should be identified only when one of the other safety threats is close to meeting the threshold in these definitions AND the caseworker has been unable to gain access to the child due to caregiver refusal. Examples include the following:

- - The child’s location is unknown to the Children’s Division, and the family will not provide the child’s current location.
  - The family has a history of keeping the child at home—away from peers, school, and other outsiders—for extended periods of time specifically to avoid assessment.

1. Current circumstances, combined with information that the caregiver has previously harmed a child in their care, suggest that the child may be in imminent danger based on the severity of the previous abuse or neglect or the caregiver’s response to the previous incident.

The caregiver has previously and severely abused or neglected a child; AND there is a current, immediate concern near the threshold for another safety threat in these definitions.

To qualify for this item, the previous abuse or neglect must have been significant. Examples include the following:

- - A caregiver alleged to have caused harm in this household in this current incident has a CPS history that includes a substantiated child death as a result of abuse or neglect.
  - A caregiver alleged to have caused harm in this household in this current incident was not successful in past reunification efforts.

1. Other (specify)

Circumstances or conditions that pose an immediate threat of serious harm to a child and are not already described in safety threats 1–13.

Note: Supervisor approval is needed for use of this safety threat.

5.3.2 Child Vulnerability

Child vulnerability refers to a child’s capacity for self-protection. For each child in the household, the practitioner must assess their vulnerability to the threat to their safety. Typically age, developmental disabilities, mental and/or physical disabilities are identified as significant factors for child vulnerability, but less obvious factors such as the visibility of the child, children targeted as the scapegoat, or children exhibiting behaviors that are provocative or irritating can also affect a child’s vulnerability.

0–5 Years

Any child in the household is under the age of 5. Younger children are considered more vulnerable, as they are less verbal and less able to protect themselves from harm. Younger children also have less capacity to retain memory of events. Infants are particularly vulnerable, as they are nonverbal and completely dependent on others for care and protection.

Diminished Developmental Or Cognitive Capacity (E.G., Developmental Delay, Nonverbal)

Any child in the household has diminished developmental or cognitive capacity that impacts their ability to communicate verbally or to care for and protect themself from harm.

Significant Diagnosed Medical Or Mental Health Condition

Any child in the household has a diagnosed medical or mental health condition that significantly impairs their ability to protect themself from harm; OR diagnosis may not yet be confirmed, but preliminary indications are present and testing/evaluation is in process. Examples include severe asthma, severe depression, or medically fragile (e.g., requires assistive devices to sustain life).

Diminished Physical Capacity (E.G., Non-Ambulatory, Limited Use Of Limbs)

Any child in the household has a physical condition/disability that impacts their ability to protect themself from harm (e.g., cannot run away or defend themself, cannot get out of the house in an emergency if left unattended).

Not Readily Accessible To Community Oversight

The child is isolated or less visible within the community (e.g., the family lives in an isolated community, the child may not attend a public or private school or be routinely involved in other activities within the community).

5.3.3 Caregiver’s Protective Capacities

Caregiver’s protective capacities refer to knowledge, ability, and/or willingness of individuals in the household responsible for the child’s care, to protect the child from the threat of danger. Primary caregivers and extended safety network are responsible for a child’s protection; therefore, the focus of safety assessment is on them. Other household members or safety network members are often protective resources that are available and accessible for use in safety planning. Once the practitioner identifies a threat to child safety and identifies the vulnerabilities of each child in the household, they must assess whether the caregiver has sufficient or diminished protective capacity to keep the child safe.

A caregiver has used their safety network in the past to address similar concerns.

At least one caregiver in the household has been able to protect the child from similar safety threats in the past through identifying a safety network and asking for help.

A caregiver has used service providers in the past to address similar concerns.

At least one caregiver in the household has been able to protect the child from similar safety threats in the past by reaching out to service providers and asking for help.

A caregiver has used court orders in the past to address similar concerns.

At least one caregiver in the household has been able to protect the child from similar safety threats in the past by using the court system to set limits with a partner/perpetrator or otherwise increase safety for the children through court involvement.

A caregiver identifies and acknowledges the safety threat(s).

There is at least one caregiver in the household who understands and can articulate the specific threat and what impact it may have on the child if it continues.

A caregiver has a supportive relationship with someone who is willing to be part of their safety network.

A caregiver in the household regularly interacts and communicates with someone who is part of their extended network of family and friends, AND that person is willing to take some action steps to address the safety threat and support child safety.

A caregiver has an accurate perception of child’s needs.

At least one caregiver in the household understands and can articulate any specific needs the child has.

A caregiver has an accurate perception of child’s capacities.

At least one caregiver in the household understands and can articulate the child’s abilities.

A caregiver is willing to take action to address the safety threat.

At least one caregiver in the household commits to taking a step to address the safety threat.

A caregiver is able to take action to address the safety threat.

At least one caregiver in the household has the capacity to address the safety threat.

A caregiver not involved in the allegation acknowledges the safety threat(s).

There is at least one caregiver who has not contributed to any safety threat, AND this protective caregiver can articulate the specific threat and its potential impact on the child if it continues.

A caregiver not involved in the allegation is willing to protect the child from future harm.

There is at least one caregiver who has not contributed to any safety threat, AND this protective caregiver is willing to take specific actions to protect the child going forward.

At least one child identifies and acknowledges the safety concern(s).

At least one child in the home understands and can articulate the threat to their safety or the safety of other children in the home.

At least one child is capable of protecting themself from a safety threat.

At least one child in the home has the intellectual or emotional capacity to ask for help or take some other action (e.g., calling 911, running to neighbor, telling teacher) to protect themself or ask for help in the home.

5.4 Structured Decision Making ® (SDM) Safety Assessment

The SDM Safety Assessment tool assists staff in assessing whether a child is likely to be in imminent danger of serious harm that may require protective intervention. The SDM Safety Assessment is required for all Investigations, Assessments, Newborn Crisis Assessments, Juvenile Assessments, and Out of Home Investigations (OHI) reports. The SDM Safety Assessment will not be required for Non-caretaker Referrals, or Preventative Service Referrals. The SDM Safety Assessment link is found on the Investigation/Assessment (IA) Home Page and will be available from the IA Monitoring Screen, Family Centered Services (FCS) Monitoring Screen, and Alternative Care (AC) Monitoring Screen. The SDM Safety Assessment may also be referred to as a “safety assessment” throughout policy.

Staff may access the SDM® Safety Assessment Policy and Procedures Manual at the below link:

https://dssintranet.mo.gov/dss-childrens-division/wp-content/uploads/sites/4/2021/12/MO-SDM-PP-Manual-Sept-2022.pdf

SDM Safety Assessment Definitions

Caregiver: An adult, parent, or guardian in the household who provides care and supervision for the child.

Family: Parents, adults fulfilling the parental role, guardians, children, and others related by ancestry, adoption, or marriage; or as defined by the family itself.

Household: All persons who have significant in-home contact with the child, including those who have a familial or intimate relationship with any person in the home. This may include persons who have an intimate relationship with a parent in the household (boyfriend or girlfriend) but may not physically live in the home or a relative where the legal parent allows the relative authority in parenting and child caregiving decisions.

5.4.1 SDM Safety Assessment Decision Outcomes

There are three outcomes of the SDM Safety Assessment:

1. Safe—No safety threats were identified and there are no children likely to be in imminent danger of serious harm and no safety intervention is needed.

1. Safe with Plan—One or more safety threats are present but based on an assessment of protective capacities, an Immediate Safety Intervention Plan and/or Temporary Alternative Placement Agreement (TAPA) can be used to control the threat. Staff should focus on if there are any safety threats identified to choose Safe With Plan. A family may have an informal or verbal plan to ensure safety, but a safety threat has to be identified to choose Safe With Plan.

1. Unsafe—One or more safety threats are present. An Immediate Safety Intervention Plan and/or TAPA were considered, but would have been insufficient to control the threat(s). Protective custody must be requested. Staff will submit a copy of the “Unsafe” safety assessment with the Juvenile Office Referral.

5.4.2 Types of SDM Safety Assessments

There are three types of SDM Safety Assessments:

1. Initial—Every Investigation, Family Assessment, Newborn Crisis Assessment, Juvenile Assessment, or OHI report should have at least one initial safety assessment, completed during the first face-to-face contact with at least one child victim in the household where there are allegations. However, if there are allegations in two households within a single report, there may be two initial safety assessments.

1. Reassessment–An assessment of any additional as well as any secondary households. The frequency of safety reassessments is described in Section 1, Ch. 5.4.2, Completing the SDM Safety Assessment below. There may be a reassessment completed if the safety of all children was not verified during the initial safety assessment/contact.

1. Closing—When the initial safety assessment was determined to be “Unsafe” or “Safe with Plan”, a safety reassessment must be completed prior to closing as a case should not be closed if safety threats are still present in a household.

A Social Service Supervisor or above has ability to override the safety decision and close a report in the following conditions:

- If a FCS or AC case IS opened and the safety decision is “Unsafe” or “Safe With Plan.
- If a FCS or AC case is NOT opened and the safety decision is “Unsafe” or “Safe with Plan”;

Examples:

- - The safety decision is “Safe with Plan”, a safety reassessment is unable to be completed, and it has been determined after supervisory consultation that the report should be closed;
  - The safety decision is “Unsafe” and the Juvenile Office has refused custody, and it has been determined after supervisory consultation that the report should be closed as nothing further can be done.

5.4.3 Completing the SDM Safety Assessment

When

For a new Child Abuse/Neglect Report, the SDM Safety Assessment is completed following the initial face-to-face contact with all child victim(s). If a report has been determined “Safe” and the investigator is instructed to call the Central Consult Unit (CCU) to consult and close a report, the CCU Specialist should enter the SDM Safety Assessment in the information system (FACES). If the report has been determined “Safe” but staying local, “Safe With Plan”, or “Unsafe”, the SDM Safety Assessment should be entered in the information system (FACES) within seventy-two (72) hours of the report date by the investigator. If staff cannot assess a household within seventy-two (72) hours, they should use information they have obtained up to that time to make a determination and enter into FACES. Staff will then complete a safety reassessment when they are able to adequately assess that household.

Example: Children physical live with their father, but the alleged perpetrator is the children’s mother who lives in a different physical residence. Staff is unable to make contact with the mother or visit her physical residence. Staff should use any statements made by the children or collaterals to make an informed decision within seventy-two (72) hours and enter into FACES. After making contact with the mother, staff will complete a safety reassessment.

Staff should attempt to see all children (victim and non-victim) per policy timeframes as well as interview the parents within 72 hours of the report being alerted. If all victim and non-victim children are not present upon initial contact and verification of safety, staff must complete a safety reassessment when the other children have been seen and verification of safety has been completed.

A safety assessment or safety reassessment must be completed in the following circumstances:

- Upon initial contact and verification of safety of all child(ren) victims on an Investigation, Assessment, Newborn Crisis Assessment, Juvenile Assessment, or OHI report;

- If an Immediate Safety Intervention Plan was initiated, a safety reassessment must be completed every ten (10) days until the child(ren) are considered “safe” before a report can be closed. See Section 1, Ch. 1.2.2 Monitoring of the Immediate Safety Intervention Plan (CD-263);

- If a TAPA is developed and FCS opened, complete a safety reassessment within ten (10) days or at the initial TDM meeting and every thirty (30) days at the ongoing TDM meetings thereafter until the TAPA is terminated. See Section 1, Ch. 1.3.5 Team Decision Making (TDM) Meetings and Section 1, Ch. 9.1.3.6 TAPA Monitoring Requirements;

- If the initial SDM Safety Assessment is marked “Unsafe” or “Safe with Plan”, a safety reassessment must be completed and the status must be “Safe” prior to closing a report unless a FCS and/or AC case is opened or after supervisory consultation, it has been determined that the report should be closed. This is entered into FACES as a reassessment of the original safety assessment;

- If a FCS case is opened on the family with a ‘Safe’ SDM Safety Assessment status at the time of case opening, complete a safety reassessment within thirty (30) days of case opening, if there is a new safety threat, and/or prior to closing to the case;

- If there is a child(ren) in AC and there are remaining children in the home, a safety reassessment must be completed within 30 days of case opening, if there is a new safety threat and/or prior to closing the case of the remaining children in the home. If at any time the remaining children are deemed unsafe in the home, a JO referral will be made;

- Prior to the recommendation of a trial home visit for a child in AC, a safety reassessment must be completed on the caregiver’s home and the safety assessment status be “Safe”;

- If a there is an open FCS or AC case, a safety assessment must be completed prior to closing as a case should not be closed if safety threats are still present in a household. See Section 1, Ch. 1.2.4 Termination of an Immediate Safety Intervention Plan (CD-263) and Section 1, Ch. 9.1.3.11 When the Juvenile Officer Declines a Children’s Division Referral (CD-235);

- Any open referrals or cases in which changing circumstances require a safety assessment or safety reassessment due to a change in the family’s circumstance, a change in information known about the family, or a change in the ability of safety interventions to mitigate safety threats.

Workers should always be on the alert to changes in the family, new dynamics, the interaction of multiple threats of danger and other “red flags” that indicate that the threat to the safety of a child is no longer manageable. If such safety threats occur, a new safety assessment should be completed.

Who

The SDM Safety Assessment is completed on households and alleged perpetrators within those households as defined by the SDM Safety Assessment definition below. If a child’s parents do not live together, the child may be considered a member of two (2) households.

Reminder: SDM defines households as all persons who have significant in-home contact with the child, including those who have a familial or intimate relationship with any person in the home. This may include persons who have an intimate relationship with a parent in the household (boyfriend or girlfriend) but may not physically live in the home or a relative where the legal parent allows the relative authority in parenting and child caregiving decisions.

The SDM Safety Assessment must be completed for the following:

- If the alleged perpetrator is part of the child’s household, assess that household;
- If the child is part of two households, assess the household of the alleged perpetrator;
- If the child is part of two households and there are allegations of harm in each household, complete two safety assessments, one for each household;
- If the alleged perpetrator is not a member of the child’s household, but there is a failure to protect allegation of the child’s caregiver, complete a safety assessment for the child’s caregiver’s household;

There can be a need to have two (2) initial safety assessments. This will allow for a safety assessment to be completed on a primary household and a secondary household if needed. Once the initial safety assessment is approved, then safety reassessments can be done as many times as needed for each of the two (2) households.

Examples:

- - If the child lives a portion of the week with mother and a portion of the week with father, the child is considered to be a part of two households. The allegations are against the father for abuse. The safety assessment would be completed on the father’s household as he is the alleged perpetrator.

- - If the child is a member of both mother and father’s household and there are allegations against both of the parents, complete two safety assessments, one on each household.

A SDM Safety Assessment does not need to be completed on the primary parent/caretaker if there are no allegations against them in their household.

Example: A child lives with mother, but is sexually abused by an uncle that lives down the street. We have found no reason to allege failure to protect or any other allegation against the mother, so a safety assessment would not be completed on the mother. A safety assessment would be completed on the uncle after determining that the legal parent (mother) allowed the authority in parenting and/or child caregiving decisions to go to this person as he is thus considered part of the household.

- - For this example given that safety threats have been identified against the uncle, staff will proceed with the safety assessment through Section 1 (Factors Influencing Child Vulnerability), Section 2 (Safe Threats), and Section 3, (Protective Capacities). In Section 4 (Protective Interventions), staff will select “Yes” to “Can safety threats be controlled and the child remain safe with an immediate safety plan or TAPA?” For the Safety Decision, staff will select “Safe with Plan” and choose “Immediate Safety Plan.”
    - Staff will then complete an Immediate Safety Plan with the child’s parent to assure she can keep the child safe from the uncle.
    - When the report is ready to be concluded, a safety reassessment will be completed and if mother has continued to keep the child safe from the uncle, staff will choose “Safe” as the mother has no longer given the uncle the authority in parenting and/or child caregiving decisions

If the alleged perpetrator is not a member of the child’s physical residence, but is considered part of the child’s household based on the definition, and there is failure to protect allegation against the child’s caregiver, complete a safety assessment for the household of the child’s caregiver as well.

Example: A child lives with mother, but is sexually abused by an uncle that lives down the street. There are also allegations of the mother continuing to allow the child to visit the uncle even after she has been made aware of concerns. An additional safety assessment would be completed on the mother for failure to protect. A safety assessment would be completed on the uncle after determining that the legal parent (mother) allowed the authority in parenting and/or child caregiving decisions to go to this person as he is considered part of their household.

- - Complete the safety assessment on the uncle as described in the above example as well as completing a safety assessment on the mother due to findings of failure to protect. When the report is ready to be concluded, complete a safety reassessment on both the uncle and the mother. If all safety threats have been eliminated, both safety reassessments can be concluded as “Safe”.

A SDM Safety Assessment can have two (2) initial safety assessments. This will allow for a safety assessment to be completed on a primary household and a secondary household if needed. Once that initial safety assessment is approved then any reassessments can be done as many times as needed for each of the two (2) households. If all victim and non-victim children are not present upon initial contact and verification of safety, staff must complete a safety reassessment when the other children have been seen and verification of safety has been completed.

5.4.4 Sections of the SDM Safety Assessment

Assessment Screening Questions

The SDM Safety Assessment research base is on caregivers with an allegation of abuse and neglect. SDM defines caregiver as an adult, parent, or guardian in the household who provides care and supervision for the child. Missouri’s definition of who is considered to have care, custody, and control of a child is much broader than the SDM definition. The following questions have been developed to assist staff in determining if they should complete the SDM Safety Assessment Tool in their reports. These questions are not part of the SDM Safety Assessment, but are Missouri specific questions staff must answer on all CA/N reports to determine whether to continue with the SDM Safety Assessment tool.

1. Is this a juvenile assessment?

Yes – Stop Assessment activities; consult with your supervisor

No – Continue to next question

1. Does the report meet the care, custody, and control laws of Missouri?

Yes – continue to #2

No – Stop assessment activities; the child(ren) can be presumed to be safe UNLESS there is a failure to protect concern against the child’s caregiver(s) and then you would complete a safety assessment with the child’s caregiver. At each contact with the family, you will continue to assess for safety threats and complete a safety assessment if any safety threats are identified against the child’s caregiver.

2A. Is there an allegation against:

- - A parent or legal guardian
  - The report is a Newborn Crisis Assessment
  - Other members of the child’s household per the SDM definition of “household”
  - Any adult person who has access to the child based on relationships to the parents of the child or members of the child’s household or family – HOWEVER – this must be someone where the legal parent has allowed the authority in parenting and child caregiving decisions to go to this person.
  - Any unknown perpetrator that based on the information available, this person could meet the CCC guidelines mentioned above

Yes – Complete the SDM Safety Assessment Tool on the household of the person with the allegation.

2B. Is there an allegation against:

- - School personnel, contractors and volunteers.
  - Any person who takes control of the child by deception or force or coercion
  - Any adult person who has access to the child based on relationships to the parents of the child or members of the child’s household or family – where the legal parent has NOT allowed the authority in parenting and child caregiving decisions to go to this person.
  - Any unknown perpetrator that does not meet the CCC guidelines mentioned above
  - Any parent or legal guardian of a child who is currently in Alternative Care
    - If the child is in alternative care and home on trial home placement, complete the safety assessment as outlined in 2A.

Yes- Continue with the Investigation, Family Assessment or Newborn Crisis Assessment but do not complete the SDM Safety Assessment Tool. The child(ren) can be presumed to be safe UNLESS there is a failure to protect concern against the child’s caregiver(s) and then you would completed a safety assessment with the child’s caregiver. At each contact with the family, you will continue to assess for safety threats and complete a safety assessment if any safety threats are identified against the child’s caregiver.

1. Is this a Fatality report where the victim child(ren) is deceased and there are no other children in the home?

Yes – Continue with the investigation, assessment or Newborn Crisis Assessment but do not complete the SDM Safety Assessment.

SDM Safety Assessment

Section 1: Factors Influencing Child Vulnerability

Assess the following conditions that may impact the child’s ability to protect self. Select all that apply to any child in the household.

- Age 0–5 years;
- Diminished developmental or cognitive capacity (e.g., developmental delay, nonverbal);
- Significant diagnosed medical or mental health condition;
- Diminished physical capacity (e.g., non-ambulatory, limited use of limbs);
- Not readily accessible to community oversight.

Section 2: Safety Threats

Assess household for each of the following safety threats. Indicate whether currently available information results in reason to believe a safety threat is present. Select all that apply:

1. Caregiver caused serious physical harm to the child or made a plausible threat to cause serious physical harm in the current investigation.

If yes, indicate if safety threat is based on:

- - - Serious injury or abuse to the child other than accidental.
    - Threat to cause harm or retaliate against the child.
    - Excessive discipline or physical force.
    - Drug-/alcohol-exposed infant during pregnancy

1. Child sexual abuse is suspected, AND current circumstances suggest that the child may be in imminent danger.

If yes, indicate if safety threat is based on:

- - - Sexual abuse
    - Sexual trafficking

1. Caregiver does not meet the child’s immediate and basic needs for supervision, food, or clothing.
2. Caregiver does not meet the child’s immediate needs for medical or mental health care.
3. Caregiver’s current substance abuse impairs their ability to supervise, protect, or create a safe environment for the child AND the child has been harmed or is likely to be harmed without intervention.
4. Caregiver’s current emotional instability, developmental status, or intellectual disability impairs their ability to supervise, protect, or care for the child AND the child has been harmed or is likely to be harmed without intervention.
5. Domestic violence exists in the household and poses an imminent danger of physical and/or emotional harm to the child.
6. The physical living conditions are hazardous and immediately threatening to the child’s health and/or safety.
7. Caregiver acts toward the child in negative ways that cause severe psychological/emotional harm to the child.
8. Caregiver is unable OR unwilling to protect the child from serious harm or threatened harm by others.
9. Caregiver’s explanation for the injury to the child is questionable or inconsistent with the type of injury, AND the nature of the injury suggests that the child’s safety may be of immediate concern.
10. The family refuses to allow the Children’s Division to assess the child, and child safety cannot be determined any other way.
11. Current circumstances, combined with information that the caregiver has previously harmed a child in their care, suggest that the child may be in imminent danger based on the severity of the previous abuse or neglect or the caregiver’s response to the previous incident.
12. Other (specify)

If there are no identified safety threats in the household, the safety decision will then be “safe”.

Section 3: Protective Capacities

Only complete this section if one or more safety threats are selected. Document caregiver capacities if present for any caregiver based on information gathered (select all that apply):

- A caregiver has used their safety network in the past to address similar concerns.
- A caregiver has used service providers in the past to address similar concerns.
- A caregiver has used court orders in the past to address similar concerns.
- A caregiver identifies and acknowledges the safety threat(s).
- A caregiver has a supportive relationship with someone who is willing to be a part of their safety network.
- A caregiver has an accurate perception of child’s needs.
- A caregiver has an accurate perception of child’s capacities.
- A caregiver is willing to take action to address the safety concern.
- A caregiver is able to take action to address the safety concern.
- A caregiver not involved in the allegation acknowledges the safety threat(s).
- A caregiver not involved in the allegation is willing to protect the child from future harm.
- At least one child identifies and acknowledges the safety concern(s).
- At least one child is capable of protecting themself from a safety concern.
- Other (specify)

For any and all protective capacities selected, staff are required to document and provide details that demonstrate the presence of that capacity.

Section 4: Protection Interventions

If safety threats have been identified in the household, consider the child vulnerabilities and the protective capacities to determine if the child can be maintained in a family-based setting with an Immediate Safety Intervention Plan or Temporary Alternative Placement Agreement (TAPA). (See Section 1, Chapter 9, Safety Planning) Use that to answer the following question:

Can the safety threats be controlled and can the children remain safe with the use of an immediate safety plan or TAPA?

1. Yes–The safety decision is ‘safe with plan’. One or more safety threats are present; however, based on an assessment of the protective capacities, an Immediate Safety Intervention Plan and/or TAPA can be used to control for the threat.

Indicate which of these interventions will be a part of your plan. (Select all that apply.)

Family Actions

- - Alleged perpetrator will leave the home.
  - Protective caregiver will take the child and leave the home.
  - Child will stay with a non-residential caregiver.

Safety Network Actions

- - Safety network members are willing to take action as part of the immediate safety plan.
  - Safety network members are able to take action as part of the immediate safety plan.
  - A safety network member agrees to live in the home for a period of time.

Caseworker Actions

- - Caseworker has shared the specific safety threat with caregiver(s) in the household.
  - Caseworker has shared the specific safety threat with members of the safety network.
  - Caseworker will participate in action steps on the immediate safety plan.

Safety Interventions Provided by Community Agencies or Service Providers

- - Service provider to participate in action steps on the immediate safety plan.
  - Use of tribal, Native American community service agency, and/or ICWA program resources.
  - Other (specify)

2. No—The safety decision is ‘unsafe’. One or more safety threats are present. An Immediate Safety Intervention Plan and TAPA were considered but would have been insufficient to control for the threat(s). As a result, protective custody is the only intervention possible for one or more children. Without protective custody, one or more children will remain in imminent danger of serious harm.

If the assessment results in a recommendation of “unsafe,” identify which children will be included in the request seeking protective custody and make a referral to the juvenile officer by submitting a CD-235. If there are children who you believe can safely remain in the home, document rationale for why they should not be included in the referral.

5.5 Caregiver Capacity and Impairment

Purpose

Every child needs a safe and unimpaired caregiver – whether that is a parent, guardian, resource provider, or anyone with care, custody, and control of the child. The caregiver must be able to provide appropriate supervision, nutrition, emotional support, and respond in emergency situations to reasonably ensure the child’s health, safety, and well-being. As part of their work, staff must assess a caregiver’s use of substances, both legal and illegal, to assess the potential safety risks that could lead to abuse and neglect. In other circumstances, staff must assess the caregiver’s substance use in terms of the safety risks that may have led to past abuse or neglect.

When assessing the child’s safety, staff must use the information gathered from the SDM Safety Assessment to clearly articulate the child’s particular vulnerabilities, threats to the child’s safety, and the caregiver’s protective capacities based on evidence that staff observe or gather from interviews, home visits, prior history checks, etc. Such information should guide staff when evaluating whether a caregiver’s use of substances may pose a risk to a child’s safety or satisfies the elements of abuse or neglect. For more information on understanding and assessing child safety, review Section 1, Chapter 5 of the Child Welfare Manual.

General Policy for Caregivers

A child’s caregiver should not be impaired by any drug or substance, whether legal or illegal (including marijuana and marijuana infused products for medical use; prescription or non-prescription medication; alcohol; or any other substance which may cause impairment) while caring for the child.

For purposes of this policy, “impairment” or “impaired” means the caregiver’s substance use negatively impacts their protective capacities over the child to such an extent that the caregiver is unable to care for the child and the child is not safe.

A caregiver shall not manufacture, distribute, dispense, possess, or use illegal substances in the presence of a child. Additionally, a child shall not have access to any legal or illegal substances, including but not limited to prescription drugs, marijuana for medical use, or alcohol that creates a risk of safety or harm to themselves or others.

When considering the child’s access to a substance, staff should assess how the substance is stored while taking into consideration the age of the child. Staff should consider the following:

Is the substance in close reach to the child?
Where is the substance stored? (e.g. on a table, above the counter, in locked storage, etc.)
Does the caregiver use the substance around the child?
If so, what is the effect on the child?

A child shall not live or be exposed to unsafe environmental conditions as a result of a caregiver’s substance use. Examples of unsafe environmental conditions include, but are not limited to, the following: access to substances harmful to children which are in reach of children; evidence of fire hazards (e.g. visible wires or overloading of electrical outlets); and unsafe air quality (e.g. visible smoke or a lack of proper ventilation).

Evidence of unsafe environmental conditions could also be in the form of detrimental health effects to the child, such as asthma or bronchitis. Such evidence must be based on a child’s medical history and presentation of illness in the child, such as excessive coughing or difficulty breathing.

Staff should always and continuously assess for evidence that a caregiver’s substance use creates a safety threat to the child.

SDM Safety Threat: Caregiver’s current substance abuse impairs their ability to supervise, protect, or create a safe environment for the child AND the child has been harmed or is likely to be harmed without intervention.

Co-sleeping with an infant or young child while under the influence of alcohol or other substances.
Driving under the influence of alcohol or other substances with a child in the car.
Being unable to provide immediate care and/or supervision to a child in the event of an emergency or other essential need while under the influence of alcohol or other substances.

There is drug production/paraphernalia in the home that are immediately accessible by the child. Consider child’s age and stage, physical proximity of the substances, and child’s daily routine to determine whether substances are immediately accessible.

All caregivers for children shall follow the Department of Health and Senior Service’s regulations for Medical Marijuana in 19 CSR 30-95, as applicable. In the event of an open Investigation, Family Assessment, or foster care case, the worker may request verification of the physician certification and identification card(s) as defined in 19 CSR 30-95.010(17) from the caregiver or household member, including any authorized caregiver for the child.

All resource and respite providers shall follow the Physical and Environmental Standards for Foster Homes in 13 CSR 35-60.040, as stated in Section 6 of the Child Welfare Manual, Resource Development.

Questions regarding the use of medical marijuana may be referred to the Division of Legal Services.

Marijuana for Medical Use by Foster Children

Case managers shall not serve as a legal guardian to consent to issue a Patient Identification Card for the medical use of marijuana on behalf of children in the legal custody of Children’s Division. Furthermore, case managers shall not act as a caregiver for the administration of marijuana for medical use on behalf of children in the legal custody of the Children’s Division.

In the event that a child enters foster care with a Patient Identification Card, or in the event that a member of the child’s family support team (FST), medical professional, or other individual recommends marijuana for medical use for a child in the legal custody of the Children’s Division, the case manager shall refer the recommendation to the Regional Director through supervisory lines and submit a referral to the Division of Legal Services.

5.6 CA/N Reports and Non-CA/N Referrals Involving Fentanyl

While many substances are harmful to children and diminish caregiver protective capacities, fentanyl poses a significant safety threat because of its particularly lethal nature. Therefore, it is necessary to have additional policy and procedures in place specific to the Children’s Division’s response to CA/N Reports and Non-CA/N Referrals involving presence of fentanyl in the home or fentanyl use by a child’s caregiver or household member. This policy does not address concerns of fentanyl use by the child. For the purposes of this policy, the term “report” refers to any CA/N Report or Non-CA/N Referral with concerns involving fentanyl. Fentanyl also includes fentanyl analogues (e.g., acetylfentanyl, acrylfentanyl, carfentanil, furanylfentanyl) and novel synthetic opioids (e.g., U-47700).

5.6.1 Before Attempting Contact with the Family

When an allegation of fentanyl use or fentanyl being present in the home is received by the Circuit, the worker will consult with a supervisor to discuss steps to be taken before attempting to make initial contact with the child(ren) and family, including any precautionary steps such as personal protective equipment (PPE). The supervisor will then inform the Circuit Manager of the report as an oversight measure.

If the report is received as an investigation, the worker will contact law enforcement to co-investigate prior to conducting the home visit. If the report is received as an assessment, the worker should request law enforcement accompany them to the home to assist in assessing the allegations. Law enforcement’s presence at the home visit should also be requested as an additional worker safety measure.

5.6.2 Circuit Manager Consultation

No report or Newborn Crisis Assessment (NCA) involving allegations of fentanyl is appropriate for consultation with the Central Consult Unit (CCU) unless fentanyl was administered by a medical professional. For example, if during childbirth, the mother is given fentanyl and there are no other concerns for fentanyl and the report or NCA meets all other CCU eligibility criteria, it may go through CCU.

The worker and supervisor will consult about safety planning, interpretation of the fentanyl drug screen results, if applicable, and all case decisions with the Circuit Manager or their designee (Field Support Manager, Program Administrator, Program Manager, Regional Director) as they arise. This consult(s) should be documented in the computer information system (FACES). Intensive In-Home Services (IIS), a Juvenile Office Referral (CD-235) recommending court ordered Family Centered Services (FCS), or any other relevant and available service should be considered when safe and appropriate to do so.

The Circuit Manager Consultation does not take the place of a Chief Investigator Consult but it may occur during a Chief Investigator Consult.

Once the Chief Investigator confirms the report is ready for approval, they will then forward it to the Circuit Manager or their designee for review and final approval. The Circuit Manager’s approval must be documented either on the Conclusion Approval/Administrative Review Notes box in the information system (FACES) or by approving the report conclusion.

5.6.3 Prescriptions

If it is found that fentanyl has been prescribed to the alleged perpetrator or other household member(s) by a medical professional, the worker will continue the investigative or assessment process as outlined in Section 2, Intake of the Child Welfare Manual. The worker should discuss with the prescribed user(s) the form and dosage of the medication, how they can provide appropriate supervision, nutrition, emotional support, and if they are able to respond in emergency situations to ensure the child(ren)’s health, safety, and well-being. The worker should stress the importance of storing all medication out of the reach of the child(ren), such as in a locked storage box, and discuss plans with all household members to ensure that the fentanyl is always stored and disposed of safely.

The worker should observe where the fentanyl is stored and address any storage concerns at that time. The worker should document how the fentanyl is stored by taking photographs on their work-issued device. See Section 2, Ch. 5.2.15, Collection of Evidence for further information about photographs.

Prescribed fentanyl can be administered in a number of ways. The worker should discuss how any packaging or other materials left after the administration of fentanyl, such as patches, will be disposed of safely.

Workers should also discuss the importance of having Narcan available in the event of accidental ingestion or overdose.

The prescribed user(s)’s physician should be contacted to confirm the prescription and dosage of the medication.

The worker and supervisor must still consult with the Circuit Manager as described above.

5.6.4 Safety Response

Upon initial contact with family, the worker should discuss all allegations of the report including the allegation of the presence of fentanyl in the home or fentanyl use by a child’s caregiver or household member.

If the report did not initially indicate concerns for fentanyl, but concerns for fentanyl are discovered, the worker should immediately consult a supervisor. The worker or supervisor should also ensure the Circuit Manger, or their designee, is immediately notified. Once concerns for fentanyl are discovered, the procedures outlined in this policy should immediately begin.

For purposes of this policy, Children’s Division considers the home to include the vehicles of any household member.

Procedures specific to the following scenarios are outlined below:

- Admission or Confirmation of the Presence or Use of Fentanyl in the Home
- Admission or Confirmation of Fentanyl Use Outside the Home
- Denial of the Presence and Use of Fentanyl in the Home
- Concerns of Child Exposure to Fentanyl
- Inability to Confirm Fentanyl Use
- No Evidence of Fentanyl Use

Admission or Confirmation of the Presence or Use of Fentanyl in the Home

A safety threat is present if:

- The alleged perpetrator or other household member(s) confirms there is unprescribed presence or use of fentanyl in the home; or
- The worker finds evidence there is presence or use of unprescribed fentanyl in the home; or
- When law enforcement has found unprescribed fentanyl in the home resulting in the hotline.

The worker should immediately work with the family to determine the most appropriate plan to eliminate the safety threat by developing an Immediate Safety Intervention Plan (ISIP) or a Temporary Alternative Placement Agreement (TAPA). An ISIP or TAPA is only appropriate if the child(ren) leaves the home to reside in a different home with a safe parent or legal guardian because the physical living conditions should be considered hazardous and immediately threatening to the child’s health and/or safety.

Workers should try to minimize any personal items taken from the home to reduce the risk of exposure to the worker, the child(ren), and the members of the safety network that will be caring for the child during the ISIP or the TAPA. All items taken from the home should be thoroughly washed with soap and water.

If neither an ISIP or a TAPA is appropriate, a referral to the Juvenile Office (CD-235) recommending removal from the home should be made immediately and without delay. However, the worker will also contact their supervisor immediately to schedule a Team Decision Making Meeting© (TDM™).

The development of the ISIP or TAPA must address how all caregivers will provide a living environment for the child(ren) to prevent the risk of fentanyl exposure. To assist the caregiver, the worker should provide the caregiver the Fentanyl Exposed Home Checklist (CD-337). If the caregiver continues living at the home in question, this checklist should be completed prior to the child(ren) returning home.

Admission or Confirmation of Fentanyl Use Outside the Home

A safety threat is possibly present if the alleged perpetrator or other household member(s) confirms the use of fentanyl in environments outside of the home or the worker finds evidence of fentanyl use outside of the home that the child may be exposed to.

If the alleged perpetrator or other household member(s) confirms their fentanyl use, but it is not known whether this has occurred in the home or in the presence of the child(ren), the worker should evaluate whether the use impairs their ability to supervise, protect, or create a safe environment for the child and whether the child has been harmed or is likely to be harmed without intervention. The worker must also consider whether the child(ren) has been exposed to fentanyl and should follow procedures outlined in the Concerns of Child Exposure to Fentanyl scenario below.

For Newborn Crisis Assessments involving unprescribed fentanyl, if the infant or the mother’s toxicology results are positive for fentanyl, the worker should treat this like a confirmation of fentanyl use outside the home.

If it is determined, in consultation with the supervisor and the Circuit Manager, as outlined above, that the caregiver(s) may be unable or unwilling to ensure the child will have a safe and unimpaired caregiver at all times, a safety threat is present. The worker should make a referral for an initial TDM™ to explore all options available to the family. A Referral to the Juvenile Office (CD-235) should also be completed to notify the Juvenile Office. The Children’s Division’s recommendation for further action, if any, in the CD-235 should be based on the facts and circumstances of each case, including an assessment of child safety and risk and any TDM™ recommendations.

Denial of the Presence and Use of Fentanyl in the Home

When there are allegations of the presence or use of fentanyl in the home and the alleged perpetrator or any household member(s) denies the presence and use of fentanyl in the home, the worker should request that they submit to a drug test, inclusive of a fentanyl panel, within 24 hours. The worker must immediately obtain collateral contacts per policy in Section 2, Ch. 5.2.12, Safety Network, Witness, and Collaterals Contacts and review all relevant information, including but not limited to, Children’s Division and criminal history.

If the drug test results are positive for fentanyl or the information available suggests the likelihood of fentanyl use, safety planning should begin immediately as outlined in the Admission or Confirmation of the Presence or Use of Fentanyl in the Home scenario above.

Concerns of Child Exposure to Fentanyl

When there are allegations that a child(ren) has been exposed to or has tested positive for fentanyl, the worker will immediately request that the child(ren) and any other household children be examined by a medical professional within 24 hours. If the child(ren) has been exposed but has not been drug tested, this evaluation should include a drug test with a fentanyl panel.

If the child does not have Medicaid coverage and the parent has no other financial means, Children’s Treatment Services (CTS) drug testing may be utilized if, after consultation with the supervisor and the Circuit Manager, it is determined necessary to assess the safety of the child(ren). The use of CTS drug testing for the child(ren) should be prioritized over testing the alleged perpetrator or other household member.

If the child(ren) tests positive, safety planning should begin immediately as outlined in the Admission or Confirmation of the Presence or Use of Fentanyl in the Home scenario above.

If the parent(s) refuse to have the child(ren) examined by a medical professional, this should be treated as an inability to confirm as outlined in the Inability to Confirm Fentanyl Use scenario below.

Inability to Confirm Fentanyl Use

If the alleged perpetrator or household member(s) initially agrees to submit to a drug test for fentanyl, but does not complete it within the requested timeframe, refuses to submit to a drug test for fentanyl, or there is not reasonable access to drug testing services, the worker should consider whether the child(ren) will have a safe and unimpaired caregiver at all times who is able to provide appropriate supervision, nutrition, emotional support, and respond in emergency situations to ensure the child(ren)’s health, safety, and well-being.

If it cannot be determined, in consultation with the supervisor and the Circuit Manager as outlined above, that the caregiver(s) is able to ensure the child will have a safe and unimpaired caregiver at all times, a referral should immediately be made for an initial TDM™.

No Evidence of Fentanyl Use

If the alleged perpetrator or household member tests negative for fentanyl and, after thorough assessment/investigation, there is no other evidence of the presence or use of fentanyl, the worker will continue the investigative or assessment process as outlined in Section 2, Intake of the Child Welfare Manual.

5.6.5 Monitoring Immediate Safety Intervention Plans (ISIP) and Temporary Alternative Placement Agreements (TAPA)

Before agreeing to terminate any ISIP or TAPA put in place as a result of this policy, the caregiver should complete the Fentanyl Exposed Home Checklist (CD-337) and the worker should conduct a home visit. The following are examples of how the worker can assess whether the home has been cleaned:

- Ask to view the cleaning supplies used.
- Compare the current conditions to photographs taken of the home at any prior home visit.
- Ask questions about how they went about cleaning the home.
- Did anyone help clean the home? If so, verify this with the helper.

Workers should not take any action during the home visit that would jeopardize their safety in case fentanyl is still present in the home.

In addition to the monitoring requirements of an ISIP as outlined in Section 1, Ch. 9.3.1.2, Monitoring of the Immediate Safety Intervention Plan (CD-263), a Circuit Manager Consultation must be held prior to the termination of any ISIP put in place as a result of this policy.

In addition to the monitoring requirements of a TAPA as outlined in Section 1, Ch. 9.3.2.6 TAPA Monitoring Requirements, a TDM™ must be held to discuss the termination of any TAPA put in place as a result of this policy.

If an ISIP or a TAPA is in place, but there is no real likelihood the safety threat can be mitigated within a reasonable time under an ISIP or a TAPA, a TDM™ should be held to consider the need for a Referral to the Juvenile Office (CD-235). Refer to Section 1, Ch. 9.3.1.1, Duration of the CD-263 and Section 1, Ch. 9.3.2.8, Duration and Termination of the TAPA for further information.

5.6.6 Cautious Use of Authority

Workers must exercise extreme caution to not threaten families with the removal of their child(ren) if they decline to enter into an ISIP or a TAPA or any other safety intervention. ISIPs and TAPAs are voluntary agreements and families have the right to refuse to participate. Refer to Section 1, Ch. 9.4 Cautious Use of Authority for additional information.

5.6.7 Out of Home Investigations (OHI)

This policy is generally applicable to reports assigned to OHI that involve concerns of fentanyl. It is the responsibility of the local office, not OHI, to assess whether the child has a safe and unimpaired caregiver at all times and to complete the procedures outlined in this policy.

When an allegation involving fentanyl is received by OHI, OHI will notify the local office immediately to begin coordinating the Children’s Division’s safety response. This notification should include the Circuit Manager, or their designee, and any other local staff necessary to ensure a timely response.

The OHI worker will consult with a supervisor to discuss steps to be taken prior to attempting to make initial contact with the child(ren) and family, including any precautionary steps such as personal protective equipment (PPE). The supervisor will then inform the OHI Unit Manager of the report as an oversight measure.

Circuit Manger Consultations should occur as outlined in this policy, but these consults should also include all involved agency staff, such as OHI, licensing, and alternative care staff.

If the report did not initially indicate concerns for fentanyl, but concerns for fentanyl are discovered, the OHI worker should immediately consult a supervisor. The OHI worker or supervisor should also ensure the OHI Unit Manager and Circuit Manger are immediately notified. Once concerns for fentanyl are discovered, the procedures outlined in this policy should immediately begin.

Once the OHI supervisor confirms the report is ready for approval, they will then forward it to the OHI Unit Manager for review and final approval. The OHI Unit Manager’s approval must be documented either on the Conclusion Approval/Administrative Review Notes box in the information system (FACES) or by approving the report conclusion.

CHILD WELFARE MANUAL

Section 1, Chapter 5 (Understanding and Assessing Child Safety)

Section 1 (Practice Model Overview)