Section 2, Chapter 4 (Non-Child Abuse/Neglect Referrals), Subsection 1 – Preventive Service “P” Referrals

(Effective 04/15/19)

Table of Contents

4.1 Preventive Service “P” Referrals

4.1.1 Safe Place for Newborns Act


4.1 Preventive Service “P” Referrals

The following is a list of steps that local office staff should consider taking in order to address the reported concern and to connect families with appropriate community resources.  Regardless of the nature and extent of the reported concern, staff must contact the reporter within forty-eight (48) hours, unless information indicates an emergency situation such as a child is threatening suicide, in which case the reporter should be contacted as soon as possible.  Staff should discuss the situation with the reporter and seek supervisory consultation as needed to determine the most appropriate response, which may include any or all of the following list of possible actions taken.

Possible P-Referral “actions taken” are as follows:

  1. The reporter is made aware of appropriate community resources they can provide to the family.
  2. Staff may contact the family by telephone to assist the family in making appropriate referrals.
  3. Collateral contacts may be necessary to address the concerns.
  4. Staff may contact the family to obtain additional information and assess the needs of the family.  If interviews of the children are necessary they should be conducted with the permission of the parent/guardian.  However, in some rare situations (e.g. a child is threatening suicide and the reporter believes it is not in the child’s best interest to contact the parents) an interview with the child without parental permission may be appropriate.  The reasons for not contacting the parents must be thoroughly documented.
  5. A home visit may be necessary to address the concerns.
  6. Staff may determine that, based upon additional information, a CA/N report is necessary.  If so, staff should make a field report to CANHU.
  7. The family may present a need for services, which may be linked within the community or surrounding area.  Staff may assist the family in obtaining services.
  8. The family may present a need or request for Family Centered Services (FCS). Supervisory consultation should be obtained prior to referring a family to FCS in response to a P-Referral.
  9. Referrals received on families with an open FCS or AC case should be given to the case manager whenever possible.  If the referral is assigned to the county in which the child is residing for the next 24 hours, the case manager should be informed and, if necessary, involved in the completion of the referral process.  However, in this situation, it would be the responsibility of the county which received the referral assignment to complete the referral process (including documentation in FACES) or arrange for it to be transferred to the case manager county at the discretion and agreement of each county.
  10. The child may be in need of placement in alternative care due to situations that are not a direct result of child abuse and neglect.
  11. For P-Referrals received because of concerns that a registered sex offender has access to children, staff should notify law enforcement to determine if the offender is in compliance with their registration requirements.
  12. For P-Referrals received on newborns born to parents with significant prior history, staff should consider taking the following steps, similar to completing a Newborn Crisis Assessment:

Contact medical personnel to gather information on:

Complications related to the pregnancy and/or birth;

Parent’s self-report of prior parenting experience and/or history with child protective services;

Concerns for the release of the infant to their parent(s)/caretaker(s);

Signs and symptoms of parental drug use or drug exposure at birth;

Parent/caregiver behavior while hospitalized; or,

Other concerns noted by the physician or health care provider which include: Safety concerns for the infant; the infant’s specific vulnerabilities; the parent/caretaker’s protective capacities.

Complete prior history checks in all states in which there is suspicion of prior child protective services involvement.  Staff should request any applicable records from states in which prior involvement is confirmed. 

Complete face to face visits with the parents and/or other identified caretakers at the hospital, if the child is still hospitalized, and in their home(s) if they are no longer hospitalized.  Staff should assess the plans and abilities each parent/caretaker has with regard to caring for the infant upon release.  Staff should complete home visits in every home the infant is going to reside and/or spend a significant amount of time, including the home of the parents and/or other familial caretakers.  The following should be determined while interviewing the parents and/or other familial caretakers involved with the direct care of the infant:

Prenatal care;

Pregnancy complications (i.e., premature labor);

Physical, emotional, intellectual functioning;

Observation of attachment and bonding with the infant;

Parenting skills (infant and other children);

Planning for birth/hospital discharge (i.e., infant’s baby supplies, crib, bottles, formula);

Behavior associated with alcohol/drug use;

Self-identifying problems associated with alcohol/drug use;

Criminal history.

Contact with other agencies involved with the family to determine and coordinate support, if appropriate.

If staff feels an infant should not be released with the parents or other familial caretaker a referral to the juvenile court should be made.

As appropriate, utilize the Newborn Crisis Assessment Tool (NCAT) to document information gathered.

4.1.1 Safe Place for Newborns

Pursuant to Section 210.950, RSMo., the Safe Place for Newborns law allows a parent to permanently give up a newborn up to 45 days old without prosecution, as long as it is done safely and the infant has not been abused or neglected.  A parent may only deliver the child to a firefighter, an emergency medical technician (EMT), law enforcement officer, maternity home, pregnancy resource center, hospital staff, or place the child in a newborn safety incubator.  Pursuant to Section 210.950, RSMo, a newborn safety incubator is defined as a medical device used to maintain an optimal environment for the care of a newborn infant. 

A parent voluntarily relinquishing a child under the Safe Place for Newborns Act is not required to provide any identifying information about the child or the parent.  Law enforcement and state agency employees are prohibited from attempting to locate or determine the identity of the parent.  If any information is obtained regarding the relinquishing parent, the law restricts who can receive that information.

Firefighters, EMTs, law enforcement officers, maternity home personnel, pregnancy resource center personnel, and hospital staff can take physical custody of the child or the child can be placed in a newborn safety incubator.  If the child is not already at a hospital, the individual taking physical custody must immediately take the child to the nearest hospital.  The hospital can treat the child, if necessary.  Such authorized personnel are immune from civil, criminal, and administrative liability for accepting physical custody of the child pursuant to this act as long as the person acts in good faith. 

The hospital must call the Children’s Division toll-free Child Abuse and Neglect Hotline number and contact the local juvenile office.  Those calls are then given to the nearest Children’s Division office as a Preventive Service Referral.  The juvenile officer must immediately begin protective custody proceedings and request the child be made a Ward of the Court for placement with the Children’s Division.

Relinquishing a child under the Safe Place for Newborn Act implies consent for the child removed from the relinquishing parents’ custody and also a voluntary relinquishment of their parental rights.  When a parent gives up custody of a child to one of the professionals mentioned above, the juvenile officer may petition the court to terminate the parental rights of the child to free the child for adoption.  When the juvenile officer files the petition, the juvenile officer must publish a public notice that a child has been relinquished by the parent.  The other parent who is not giving up custody must identify himself/herself to the Court within thirty (30) days and state what his/her intentions are toward the child.  The court must initiate proceedings to establish paternity or maternity within thirty (30) days of the non-relinquishing parent coming forward.  If he or she fails to start the process within 30 days, that parent may lose all parental rights to the child.  The putative father registry must also be checked to determine whether attempts have previously been made to preserve parental rights of the child.  If the non-relinquishing parent fails to start the process to establish parentage within thirty (30) days after the public notice, their parental rights may be terminated.

The decision to give up a baby is a very important decision for the baby and for the parents of the child.  Staff cannot give legal advice and should advise anyone who may have questions about whether or not giving up his or her baby under this law is the right thing to do for them to talk to a lawyer.