CHILD WELFARE MANUAL

Revision Date: 6-15-2026

 

Table of Contents

4.4 Newborn Crisis Assessments (NCAs)

          4.4.1 The Comprehensive Addiction and Recovery Act (CARA) and Plans of Safe Care

4.4.2 Safe Sleeping Environments

4.4.3 Assessment Process

4.4.4 Newborns with a Sibling in the Custody of the Children’s Division

4.4.5 Birth Match

 

4.4 Newborn Crisis Assessments (NCAs)

In some instances, a physician or health care provider may be hesitant about releasing a newborn from the hospital due to concerns of parental drug use or other potentially dangerous family and/or household factors. Health care professionals may contact the Child Abuse/Neglect Hotline Unit (CANHU) with concerns. Newborns are the most vulnerable population the Children’s Division serves; they are entirely dependent on others to survive and thrive. NCAs should be assigned to tenured, well-trained team members. NCAs will be accepted until the child is one year of age.

 

4.4.1 The Comprehensive Addiction and Recovery Act (CARA) and Plans of Safe Care

On July 22, 2016, President Barack Obama signed into law the Comprehensive Addiction and Recovery Act (P.L. 114-198). CARA amended the Child Abuse Prevention Treatment Act (CAPTA), requiring each state to have policies and procedures for all newborns identified as being affected by substance abuse or withdrawal symptoms. Previously, the requirement only applied to illegal substance abuse. It also added requirements relating to data collection and monitoring.

A Plan of Safe Care shall be developed with the family, if during contacts with a medical provider(s), a newborn is identified as having been born affected by substance abuse, born with Fetal Alcohol Spectrum Disorder, suffering from Neonatal Abstinence Syndrome, experiencing withdrawal symptoms, or likely to be affected negatively in some form by parents’/caretakers’ continued use of substances.

When determining if a newborn has been “affected” by substance abuse or withdrawal symptoms resulting from prenatal drug exposure or Fetal Alcohol Spectrum Disorder, workers must assess if the newborn’s physical, mental, or general well-being is affected by the use of substances by the parent/caretaker.

Examples of when a Plan of Safe Care is needed:

• The newborn is displaying withdrawal symptoms due to exposure to substances as determined by a physician.
• The newborn is exhibiting Fetal Alcohol Spectrum Disorder symptoms as determined by a physician.

Examples of when a Plan of Safe Care could be needed:

• The newborn is not exhibiting withdrawal symptoms, but tested positive for a substance at birth, and:
  • After assessment by a physician and/or the worker, it is determined exposure and substance use could have an adverse effect on the newborn’s physical, mental, or general well-being.
  • The parent/caretaker’s continued use may adversely affect the safety and well-being of the newborn or other children in the home. This could include parent/caretaker’s inability to make coherent decisions regarding feeding, safe sleeping, caring, or transporting the newborn or other children in the home.

• The newborn is not exhibiting withdrawal symptoms, tested negative for substances at birth, and:
  • The parent/caretaker’s continued use may adversely affect the safety and well-being of the newborn or other children in the home.
  • The mother or father, who is one of the primary caretakers in the home, reports ongoing misuse of prescription opioids to manage chronic pain. While he or she states he or she does not use while directly caring for the newborn, continued substance use raises concerns about impaired judgment, safe sleep practices, and the ability to respond appropriately to the newborn’s needs.
  • The mother or father, who is one of the primary caretakers in the home, has a history of substance use and is on probation due to drug charges. The mother or father has been sober for ten months and receives drug tests regularly through Probation and Parole.
  • The mother tested positive for a substance as some point during pregnancy and/or at birth. The mother reports using marijuana occasionally for nausea throughout her pregnancy and states she only uses occasionally.

Examples of when a Plan of Safe Care may NOT be needed:

• The newborn tested negative for substances at birth, and the mother tested negative for substances during pregnancy and at birth. No concerns for substance use.
• The newborn tested negative for substances at birth. The mother tested positive for a substance once very early on in pregnancy but has not tested positive since. The mother reports using prior to pregnancy but not since knowing she was pregnant. An assessment with the mother, and input from medical provider(s) who worked with mother throughout her pregnancy, do not identify a concern for continued substance use.
• The newborn’s tests for substances are pending, and the mother tests negative for substances during pregnancy and at birth. No concerns for substance use.

The Plan of Safe Care should be developed with input from the family, the medical provider(s) who knows or has been assigned to work with the family and newborn, and any service providers providing services to the family. A Plan of Safe Care should address the health, physical safety, and substance use treatment needs of the newborn and affected family or caregivers. The plan should also address potential barriers to positive family functioning and future safety of the newborn. The worker should observe and assess the needs of each member of the family.

The Plan of Safe Care should be inclusive of, and address the following:

• Conversations with medical providers who have worked with the mother prenatally (such as an obstetrician).
• Family’s substance use patterns (including sporadic usage for pain relief or recreation, current use, and prior use).
• Parents, caregivers, and newborns’ treatment needs (such as ensuring access to treatment resources, education on how substance use can affect caregiving).
• Other identified needs that are not determined to be immediate safety concerns.
• Programs and services offered by agencies outside of Children’s Division.
• The potential for continued substance use or a potential relapse, and how to promote well-being and mitigate safety risks for the newborn as well as other children in the home.

A Plan of Safe Care should include the family’s safety network, as appropriate, including but not limited to the following:

• Caregivers and family members in the household
• Extended family and friend(s)
• Medical professional(s)
• Hospital social worker(s)
• Substance abuse provider(s)
• Mental health provider(s)
• Other service provider(s)
• First Steps
• Intensive In-Home Services and/or Family Centered Services
• Home visiting

 

4.4.2 Safe Sleeping Environments

The Safe Sleep policy is to establish uniform standards for the education, observation, discussion and documentation of safe sleep practices for infants under one (1) year of age, and in homes where a birth is anticipated. The Safe Sleep policy is to actively promote and ensure the implementation of safe sleep practices as outlined by the American Academy of Pediatrics (AAP) and Children’s Division (CD) policy. CD team members, foster care case management staff, and foster home licensing workers shall provide safe sleep education to all caregivers, assess environmental conditions for safety, have an in-depth discussion on the importance of safe sleep, and document findings as outlined below. Safe sleep practices must be reinforced at all points of contact involving families expecting a newborn and caring for infants under one (1) year of age. 

This policy applies to all cases where the provider or family is caring for or preparing to care for an infant under one (1) year of age including: 

• All open Child Abuse/Neglect (CA/N) reports, Newborn Crisis Assessments (NCA), Family Centered Services (FCS) cases, Alternative Care (AC) placements, and all resource licensing cases.

CD policy reflects guidance from the AAP, including: 

• Placing infants on their back on a firm, flat surface with a fitted sheet.
• Avoiding soft bedding and toys inside cribs.
• Practicing room-sharing without bed-sharing, ideally for the infant’s first 6–12 months.
• Avoiding smoke, alcohol, and illicit drug exposure in the home. 

CD team members, foster care case management staff, and foster home licensing workers must: 

A. Educate

• • Provide safe sleep education to all individuals caring for an infant under one (1) year of age.
  • Utilize the Safe Sleep Flyer (CD-278) and Safe Sleep Discussion Guide (CD-278A)  to have meaningful conversations about safe sleep with parents and caregivers.   
  • Discuss safe sleep barriers including but not limited to:  
    • Substance use, medication impacts
    • Household space or co-sleeping routines
    • Breastfeeding practices
    • Cultural norms and potential trauma history. 

B. Observe

• • Observe the sleep environment for safety during every home visit or placement walk-through. Identify and document concerns such as:  
    • Co-sleeping with caregivers or siblings

• • • Sleep surfaces that are soft, cushioned, or non-flat

• • • The location of blankets, pillows, bumper pads, or plush toys

• • • Stomach sleeping

• • • Instances of an infant sleeping in a car seat, swing, or similar device. 
  • Workers should attempt to take photographs of the safe sleep environment and upload them to OnBase. See CWM 2.5.2.15 Collection of Evidence for more information on photographs.            

If the family does not have a safe sleep environment, this condition shall be assessed as a safety threat under SDM Safety Threat #8: “The physical living conditions are hazardous and pose an immediate threat to the child’s health and safety.” In such cases, safety planning shall be initiated immediately to address and mitigate the identified threat. 

C. Discuss

• • If unsafe sleep environments or practices are observed, the worker must discuss why it is unsafe and provide recommendations on how to make the environment safe. Team members should utilize the CD-278 and CD-278A to help guide the discussion.
  • Discuss any barriers to providing a safe sleep environment and provide resources/recommendations to help alleviate or remove the barriers. The CD-278A can be used to help with these discussions.
  • Discuss safe sleep practices during every home visit or placement walk-through.

D. Document

• • Document safe sleep education, caregiver discussions, and environmental observations in the case record or licensing documentation. 
  • Documentation should include identified barriers and steps taken to address safety concerns. 

Resistance to Safe Sleep Practice

Parents have the right to make informed choices about their infant’s well-being, including deciding whether to adhere to safe sleep recommendations. While these guidelines are recommended by experts for safety, the Children’s Division must respect parents’ autonomy and their understanding of what is best for their family. However, all licensed and unlicensed placement providers are required to follow safe sleep practices.  Refer to the CWM 6.3.1 Resource Provider Licensing,  CWM 6.13 Resource Development Worker Responsibilities, and  CWM 6.16.3 Placement Activities/Placement Support for more information.

If after thorough education and discussion, parents elect against following safe sleep recommendations, team members should discuss ways to reduce the risk of harm to the infant. The worker should inform the family that according to the AAP the following factors increase the frequency of Sudden Unexpected Infant Death (SUID) when bed sharing or surface sharing:

• Bed-sharing with someone who is impaired in their alertness or ability to arouse because of fatigue or use of sedating medications (e.g., certain antidepressants, pain medications) or substances (e.g., alcohol, illicit drugs).
• Bed-sharing with a current smoker (even if the smoker does not smoke in bed) or if the pregnant parent smoked during pregnancy.
• Bed-sharing or surface sharing on a soft surface, such as a waterbed, old mattress, sofa, couch, or armchair.
• Bed-sharing with anyone who is not the infant’s parent.
• Bed-sharing with soft bedding accessories, such as pillows or blankets.
• Term, normal weight infants less than 4 months old, even if neither parent smokes and even if the infant is breastfed.
• Preterm or low birth weight infant.

If there are concerns regarding the parent’s decisions, the worker should consult with their supervisor for guidance and document the conversation in detail.

Working with Families with Disabilities

The Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 require child welfare agencies to provide full and equal access to their programs and services, including, but not limited to: investigations; assessments; provisions of in-home services; removal of children from their home; case planning; and service planning. When working with parents who have disabilities, workers must make reasonable modifications to policies, practices, and procedures, unless the modification would result in a fundamental alteration to the program or service. Each case and situation must be evaluated individually, and decisions should not be made based on a stereotype that a parent with a disability is incapable of safely and adequately caring for a child. If a parent has a disability, a worker should discuss possible modifications with their supervisor at the earliest opportunity and regularly throughout the duration of the case.

 

4.4.3 Assessment Process

1. Completion of the Newborn Crisis Assessment Tool (NCAT): The worker’s assessment is captured on the NCAT, along with instructions for completion. The NCAT is also used to document the Plan of Safe Care, as described in CWM 2.4.4.1 The Comprehensive Addiction and Recovery Act (CARA) and Plans of Safe Care policy section above, when the worker identifies one of the following factors during the assessment process:

• • The newborn was born affected by substance use;

• • The newborn experienced withdrawal symptoms;

• • The newborn is likely to be affected negatively in some form by the parents’/caretakers’ continued use of substances;

• • The newborn was born with Fetal Alcohol Spectrum Disorder; or
  • The newborn is suffering from Neonatal Abstinence Syndrome.

The NCAT may be completed throughout the NCA as the worker makes required contacts with the family, medical providers, and collateral contacts. The NCAT must be uploaded to OnBase upon completion.

2. Prior History Review: Workers must follow policy in CWM 2.5.2.2 Reviewing Prior History when completing NCAs. Workers should pay particular attention to prior reports for similar concerns. Prior history is a valuable tool when assessing whether the newborn will have a sober caregiver at all times. Workers should also review the prior history to help identify the putative father, if necessary. Prior history should be reviewed to ensure all children of both parents have been identified, especially when there are safety concerns for the newborn.

To prevent multiple visits with the family, it is very important for workers to complete a thorough prior CA/N and criminal history check during all NCAs. Any history that will result in a birth match, as discussed in the CWM 2.4.4.5 Birth Match policy section below, should be discussed with the family during the NCA. This will allow the Chief Investigator to combine a subsequent Birth Match NCA to the initial NCA once the birth match occurs. In order to check for birth match history available to the Children’s Division, the following must be reviewed for both parents within the time frames outlined in CWM 2.4.4.5 Birth Match policy section below:

1. 1. Call/Case Prior History Search in FACES for preponderance of evidence findings, court adjudicated findings, and termination of parental rights history.
   2. Court Adjudication Central Registry (CACR) Screen in FACES for further court adjudication findings.
   3. Case.Net

3. Reporter Contact: Workers must follow policy in CWM 2.5.2.3 Reporter Contact when completing NCAs. Workers should gather relevant information specific to the NCA process from the reporter such as:

• • Prenatal care
  • Pregnancy and delivery complications
  • Signs or symptoms of substance misuse prenatally or at birth
  • Substance use including treatment, if necessary, and the potential for continued use
  • Other medical records such as test results, discharge plans, growth chart, and postpartum care
  • Other concerns noted by a healthcare provider which may include:
    • Safety of the newborn
    • The child’s specific vulnerabilities
    • The parent/caretaker’s protective capacities
  • Observations of parent and caretaker behaviors such as attachment and bonding with the newborn, postpartum issues, and planning for birth (such as obtaining baby supplies, crib, bottles, formula)
  • Mental health needs of parents and caregivers
  • Physical, emotional, intellectual functioning of parents and caregivers
  • Domestic violence concerns and overall family functioning
  • Parenting/family support
  • Other agency involvement and service providers
  • Childcare
  • Criminal history
  • Prior CA/N history

4. Initial Safety Assurance of the Newborn: Workers must follow policy in CWM 2.5.2.5 Initial Safety Assurance of Victim and CWM 2.5.2.5.1 Use of Multi-Disciplinary Team Member for Initial Safety Assurance of Victim. NCAs are automatically assigned a Level 1 Response Priority, but when safe to do so, the Chief Investigator may consider changing the Response Priority to no greater than a Level 2 Response Priority. Examples when a different Response Priority may be considered include but are not limited to:

• • Child will not be released from the hospital for at least 24 hours or one (1) business day.
  • The child and mother have been released and the hospital received confirmation that the child tested positive for a controlled substance or alcohol, but no other concerns were noted.
  • The mother tested positive for a controlled substance during pregnancy, but neither she nor the child tested positive for controlled substances at birth.

Chief Investigators must follow all other policy in CWM 2.3.4 Response Priority Level Override when changing the Response Priority.

The worker should observe and assess the newborn. The worker should document if the newborn appears to be suffering from signs of prenatal exposure to substances and withdrawal at the time of observation and assessment, including:

• • Facial characteristics of fetal alcohol syndrome
  • Irritability
  • Irregular and rapid changes in states of arousal
  • Low birth weight
  • Prematurity
  • Difficulties with feeding due to poor suck
  • Irregular sleep-wake cycles
  • Decreased or increased muscle tone
  • Seizures or tremors
  • Excessive crying or high-pitched crying
  • Medical complications, such as those requiring treatment in a Neonatal Intensive Care Unit (NICU).

The worker should observe, assess, and document special health care needs (including the need of home health care if recommended by a physician).

5. SDM® Safety Assessment and Safety Planning: Workers must follow all Safety Assessment policies found in CWM 1.5 Understanding and Assessing Child Safety. The SDM® Safety Assessment must be entered in the information system (FACES) within seventy-two (72) hours of the call time to CANHU. Workers must follow all Safety Planning policies found in CWM 1.9 Safety Planning. If the NCA involves concerns of fentanyl use, workers must follow policies found in CWM 1.5.6 CA/N Reports and Non-CA/N Referrals Involving Fentanyl.

6. Chief Investigator Consult: Each NCA must have a Chief Investigator consult within seventy-two (72) hours of the call time to CANHU. Chief Investigators must follow policy in CWM 2.5.2.14 Chief Investigator Consult and Responsibilities. The Newborn Crisis Assessment Chief Investigator Guide (CD-327c) is available to help guide the Chief Investigator Consult

7. Parental Notification: Workers should notify BOTH parents of the NCA when possible, and preferably in-person and at the hospital prior to discharge. The worker must present identification and provide the appropriate paperwork as outlined in CWM 2.5.2.4 Parental and Alleged Perpetrator Notification, Presenting Identification and Paperwork to be Provided.

8. Contact with Non-Victim Children and Other Household Members: Workers should have face-to-face contact with the newborn’s minor sibling(s) who reside in the household no later than seventy-two (72) hours from the call time to CANHU. If the minor sibling(s) are on split visitation with another parent and there are no safety concerns or a need for a Plan of Safe Care, the worker may wait to see minor sibling(s) when they return to the newborn’s home. If there are safety concerns or if there is a need for a Plan of Safe Care, minor siblings should be seen PRIOR to returning to the newborn’s home. This may require notification and coordination with a parent, other than the mother or father to the newborn. The worker should consult with their supervisor when determining when the minor sibling(s) will be seen.

The worker must have contact with all adult household members the newborn will be residing with upon discharge from the hospital.  

Depending on the nature of the concerns of the NCA, it may be necessary to prioritize the initial safety assurance of the minor sibling(s) over the newborn if the newborn is in a protected environment.

Example: The reported concern of the NCA involves active fentanyl use in the home and the mother has two other children. The worker has verified the newborn will not be discharged until the following day. The focus of the safety assessment should shift to the minor siblings.

9. Home Visit: Workers must follow policy in CWM 2.5.2.10 Home Visit. A home visit should be completed in each parent/caregiver’s home if the newborn will be spending time in more than one household. If possible, the home visit should occur prior to hospital discharge, otherwise upon hospital discharge. Multiple home visits may be necessary to complete a thorough assessment. The home visit should assess the following:

• • Family functioning
  • Assessment of needs of all children in the home
  • Safe sleep knowledge and awareness and plans for newborn’s sleeping environment.
  • Readiness and presence of supplies for newborn’s arrival (i.e., crib, clothes, bottles)
  • Physical condition of the home
  • Each individual living in the home. Reminder: Each assessed individual needs to be entered into the information system (FACES) as a case participant
  • Other household members’ descriptions of available support, any alcohol/drug use, and any support for treatment

Workers must follow the CWM 2.4.4.2 Safe Sleeping Environments policy section above. Workers must observe the newborn’s safe sleep environment and provide safe sleep education during every visit. Workers should provide safe sleep education to each parent that will have caregiving responsibilities. Workers should photograph the newborn’s sleep environment, when granted permission by the parent. Refer to CWM 2.5.2.15 Collection of Evidence for more information.

10. Collateral Contacts: Workers must follow policy in CWM 2.5.2.12 Witnesses, Collateral, and Safety Network Contacts.

When completing a NCA where there is concern the newborn is drug exposed, the worker should also:

a) Obtain mother’s medical records: A signed by the mother is, generally, the most effective means of obtaining or disclosing her Protected Health Information (PHI) relating to the NCA. Workers should be careful to remain within the bounds of that authorization; only seek the type of records authorized in the SS-6; and only distribute those records to the people or entities listed in the authorization.

Covered entities may disclose PHI to government authorities who are authorized by law to receive reports of abuse or neglect. In the event the worker does not have signed authorization from mother, a medical provider may still disclose PHI to the worker to the extent relevant to the NCA. Workers should utilize the Medical/Professional Information Request (CS-30) to make these requests for medical records.

Additional attestation may be required when requesting records. Depending on the nature of the request and applicable regulations, further documentation, verification, or authorization may be necessary to ensure compliance and proper processing. 

Further, as the juvenile office is also a governmental entity authorized by law to receive reports of abuse or neglect or to provide child welfare services, workers may be justified in disclosing PHI to the juvenile office to the extent that it is reasonably necessary to protect a child from potential abuse or neglect.          

If mother’s PHI involves information about substance abuse or treatment, workers should pay close attention to the source of those records. If the records in question are from a substance abuse treatment program, there may be additional steps involved prior to seeking or distributing these records. Workers should consult legal counsel before doing so. If the records are from a general medical provider, such as a hospital, the worker may proceed using the guidance above.

b) Obtain newborn’s toxicology results: A CS-30 should be completed by the worker to obtain written medical documentation of the signs or symptoms of exposure at birth or toxicology test results.

c) Contact an involved medical provider: It is important that a medical provider who will continue to provide care for either the mother or the newborn is aware of any substance use concern so that the provider can be a support in the Plan of Safe Care. For example, a child’s pediatrician would be an excellent contact as the pediatrician should have ongoing contact with the child.

11. Risk Assessment, Assessing the Need for Services, and Service Provision: Workers must complete the Risk Assessment in the information system (FACES) according to CWM 2.5.2.13 Risk Assessment. The Risk Assessment should help guide decision making about case decisions.

Workers must also have a conversation with the family about Home Visiting Services. If the family accepts services, the worker should utilize the Coordinated Referral & Intake System (CRIS) to complete an online referral with the parent and follow up with the CRIS Site to ensure services were initiated. Refer to the Missouri Home Visiting Referral Map for more information of providers and regions. Workers should refer to CWM 2. 5.2.16 Assessing the Need for Services and Ongoing Case Management  for further information. The birth of a child can be a stressful time; families may benefit from community support and programs to assist in parenting and caring for their family. Workers should assess for family’s needs for support and provide referrals to community services and programs. The worker should follow up to ensure that the family followed through with referrals provided. Examples include, but are not limited to: Women, Infants, and Children (WIC), Supplemental Nutrition Assistance (SNAP), MO HealthNet, Department of Elementary and Secondary Education Office of Childhood Child Care Subsidy, Cribs for Kids, and First Steps.  

12. Concluding the NCA: The worker should confirm with a physician or health care provider before closing a case in which a physician or health care provider has made or approved a written assessment which documents the child as being at risk of abuse or neglect if the newborn was exposed to a controlled substance or alcohol at birth.

The following should be included in the information system (FACES) Conclusion Summary for Newborn Crisis Assessments:

• • Brief Summary about what took place in the report
  • Documentation of confirmed toxicology results
  • Documentation as to whether there was a Plan of Safe Care completed and documented on the Newborn Crisis Assessment Tool (NCAT)
  • Why the conclusion was made
  • Why the child is Safe, Safe With Plan, or Unsafe
  • Any services the family is participating in (if applicable)
  • Documentation of all discussions of safe sleep
  • If a case was opened, why the case was opened and anticipated action.

When approving the conclusion of a NCA, the Chief Investigator should utilize the Newborn Crisis Assessment Checklist (CD-328d) as required in CWM 2.5.2.14.7 Chief Investigator Approval of Reports.

 

4.4.4 Newborns with a Sibling in the Custody of the Children’s Division

An NCA is required for all newborns with a sibling in the custody of the Children’s Division. If an NCA is not reported by the hospital, the Alternative Care (AC) worker must call CANHU to report the birth of the newborn.

These NCAs are completed following the NCA assessment process outlined in the policy section above. The additional steps below must also be completed when the NCA for a newborn with a sibling in the custody of the Children’s Division is received. Nothing in this policy should preclude workers from taking immediate action when a safety threat is identified as outlined in CWM 1.9 Safety Planning. 

1. The worker assigned the NCA must contact the AC worker or supervisor, including Foster Care Case Management (FCCM) providers, prior to contacting the family if possible, to discuss:

1. 1. The reason for the alternative care case
   2. If the Family Support Team was aware of the pregnancy
   3. The services/supports put in place for the family
   4. Any current safety concerns in the home
   5. How the newborn will be safe in the home or why there are concerns for safety in the home, as well as the workers recommendations about the newborn remaining in the parents’ care.

2. The worker assigned the NCA will request a Family Support Team (FST) meeting to be held, within 72 hours of the call time to CANHU, to explore all options available to the family. The AC worker and/or supervisor should be included in the FST meeting and should assist the NCA worker in scheduling the meeting as needed.
3. Following the FST, the worker assigned the NCA must complete a Juvenile Office Referral (CD-235), information system (FACES), notifying the Juvenile Office of Children’s Division’s recommendation for further action, if any. The CD-235 should be based on the facts and circumstances of each case, including an assessment of child(ren) regarding the care, safety, and placement and the reasons for those recommendations. The CD-235 does not necessarily require a recommendation for protective custody.
4. If it is determined during the FST meeting a referral for Intensive In- Home Services (IIS) or Intensive Family Reunification Services (IFRS) is needed, the worker assigned the NCA should make this referral within 72 hours of the FST meeting.
5. If the Children’s Division recommends the newborn remain in the physical custody of the parent(s), a discussion of a home visiting referral must be had with the parent if it was not done during pregnancy through the AC case.
6. A joint supervisor staffing must take place between the supervisor for the worker assigned the NCA and the supervisor for the alternative care case prior to closing the NCA. The supervisors should discuss the family history and the actions taken to ensure safety of the newborn. The discussion should be documented to reflect the opinions and perspectives of both supervisors. It is the responsibility of the supervisor of the worker assigned the NCA to enter the staffing in FACES.

All NCAs involving newborns with a sibling in the custody of the Children’s Division are closed locally and are not eligible for consultation and case closure through the Central Consult Unit (CCU).

 

4.4.5 Birth Match

The purpose of the Birth Match is to assist in identifying newborns at high risk for abuse or neglect based on the parents’ previous actions. This allows workers to assess the family and determine if services are potentially needed before abuse or neglect occurs.

Section 210.156, RSMo, requires the Children’s Division to provide the Missouri Registrar of Vital Statistics identifying information for:

1. Individuals whose parental rights have ever been involuntarily terminated in Missouri AND who are identified in the Central Registry as having a finding by the Children’s Division or a court adjudication of child abuse or neglect within the previous ten years.

2. Individuals identified in the Central Registry who have also pled guilty or been found guilty of specific crimes, within the previous ten years, provided the victim was less than eighteen years of age, including: chapter 566 or section 565.020, 565.021, 565.023, 565.024, 567.050, 568.020, 568.065, 573.023, 573.025, 573.035, 573.037, 573.040, 573.200, and 573.205.

Vital Statistics then matches birth record information of children born to the individuals matching the criteria above to CANHU. Upon verifying the match, CANHU creates a Birth Match report that is alerted to the county office.

Birth Match reports are completed as an NCA following the NCA Assessment Process outlined in the policy section above. However, workers are not required to contact the reporter on Birth Match NCAs as the reporter listed, DHSS VITAL STATS-NO REPORTER, is not an actual individual.

To accurately capture Birth Match outcome data, the Chief Investigator must not duplicate the Birth Match NCA to any open or closed NCA.

The Chief Investigator may combine a Birth Match NCA to an open NCA on the family if the worker has already addressed and documented the prior history that caused the birth match with the family. If the initial NCA has been concluded, the worker may simply enter a contact in the information system (FACES) stating a Birth Match report was received and CD already discussed the prior history with the family during the initial NCA and conclude the Birth Match NCA without duplicating the NCA process. 

If the birth match prior history was not discussed and documented in the information system (FACES) during the initial NCA, the full NCA process must be completed on the Birth Match NCA.

Birth Match NCAs do not list concerns on the CA/N-1 other than “criteria meets Birth Match Program”, making it difficult for the worker to initiate discussions with the family when making contact. Below is general guidance on how the worker can introduce the reason for the Birth Match NCA when initially meeting with the family:

We received notification of the birth of your baby due to parental prior history with the Children’s Division. We are here to assess your family for services and help locate them if needed.

Workers must exercise caution in sharing the reason for the birth match. In general, a parent is considered the personal representative of their child under the Health Insurance Portability and Accountability Act (HIPAA) and has a right to know their own child’s confidential information including Protected Health Information (PHI).

However, a parent does not have a right to the confidential information of another parent, and disclosure of one parent’s confidential information to another should only occur if the parent has provided authorization.

The worker should ask one parent to step out of the room before discussing the confidential information of the other parent. If both parents choose to remain present, the worker should request the parent sign an authorization for Authorization for Release of Medica/Health Information (SS-6) before disclosing any confidential information to the other parent. If authorization cannot be obtained, the worker should refrain from disclosing confidential information in the presence of the other parent but may ask the parent about their prior history with Children’s Division, and the parent is free to disclose as much or as little as they choose.

Criminal history is not confidential information and can be shared freely when responding to Birth Match reports.

Example: A Birth Match NCA is received because of the father’s prior history with the Children’s Division, but he does not reside in the home. If safe and appropriate to do so, the worker should attempt to notify father of the report prior to contacting mother. If contact cannot be made with father, the worker should notify mother of the report and explain the reason using the statement provided above as guidance. The worker cannot disclose the Children’s Division’s specific history of the father to the mother, unless mother is entitled to the information herself, such as if the mother was involved in the prior history or the father signed a SS-6 allowing the worker to do so.

Example: A Birth Match NCA is received because of the father’s prior history with the Children’s Division, including severe physical abuse to a newborn from a previous relationship. The mother has an active restraining order against the father. The worker has concerns for mother and child’s safety if contact is made with the father. The worker should explain to the mother the reason for the Birth Match NCA using the statement provided above as guidance. 

Example: A Birth Match NCA is received because of the mother’s prior history with the Children’s Division. Both parents deny any prior involvement with the Children’s Division. The worker cannot disclose which parent has the prior history with both parents present unless the other parent is entitled to the information. For example, they were both involved in the prior history or there are signed SS-6s. The worker should talk with mom one-on-one to discuss the prior history.

Example: A Birth Match NCA is received because the father was found guilty of one of the qualifying crimes. The worker should discuss the father’s criminal charges with the mother and the father since the charges are public information.