CHILD WELFARE MANUAL

Revision Date:  6-15-2026

 

Infants are the most vulnerable population the Children’s Division (CD) serves as they are entirely dependent on others to survive and thrive. Prior or current child welfare involvement is a key risk factor of future harm.

This policy applies to parents who have children in the legal custody of CD and describes the actions to be taken prior to and after the birth of a new child, and until the child turns one year of age.

Nothing in this policy should preclude workers from taking immediate action when a safety threat is identified as outlined in the Child Welfare Manual CWM 1.9 Safety Planning.

 

4.6.6.1 Pre-Birth Assessment and Services

Assessment should begin as soon as CD obtains knowledge of the pregnancy.

The Alternative Care (AC) worker is responsible for thoroughly assessing the family and providing case management services when working with parents who have children in AC, as outlined in CWM 4.6 Working with Parents. The assessment of the family, progress toward goals, and next steps should be thoroughly documented in the electronic case record.

The Family Support Team (FST) should:

• Evaluate how the circumstances that brought the parents’ other children into CD custody may impact the newborn’s safety and wellbeing.
• Ensure the parent Social Service Plan (SSP) addresses those prior circumstances.
• Determine what adjustments should be made to the parent SSP to prepare the family for the newborn.

The AC worker must work collaboratively with the parent and service providers to establish an infant care plan including:

1. Healthcare Coordination
   • Prenatal and postpartum medical care
   • Identification and confirmation of a pediatrician
2. Basic Needs and Benefits
   • Family has sufficient income and resources to meet the infant’s needs
   • Identification, application, and receipt of community resources as needed
3. Childcare and Support Services
   • Childcare arrangements appropriate to the infant’s needs and parent’s schedules
   • Assessment of primary and alternate caregivers to ensure they are safe, unimpaired, willing and able to meet the infant’s needs
   • Identification of natural supports to supplement professional services
   • Establishment of services that promote the expected infant’s safety and wellbeing, including referring the family to Home Visiting services
4. Safe Sleep Environment
   • Education on safe sleep practices, utilizing the Safe Sleep Flyer (CD-278) and Safe Sleep Discussion Resource Guide (CD-278A)
   • Verification of a crib, bassinet or play yard that meets current safety standards

 

4.6.6.2 Post-Birth Assessment and Safety Decisions

Once the infant is born, thorough and intentional assessment must occur to determine the parent’s ability and willingness to care for and protect the infant. 

The AC worker must take the following actions in all cases in which an infant is born to a parent who has a child currently in the legal custody of Children’s Division:

• Child Abuse and Neglect Hotline: The AC worker should ensure the infant’s birth has been reported to the Child Abuse and Neglect Hotline Unit (CANHU). If a report has not been made, the AC worker must contact CANHU to make the report. The report should be taken as a Newborn Crisis Assessment (NCA). If the report is classified as a Preventive Service Referral (P Referral), the AC worker should ask to speak with a CANHU Supervisor to request the report is screened as an NCA.
• Collaborative Assessment: The AC worker, the worker assigned to complete the Newborn Crisis Assessment (NCA), and any assigned service worker must collaborate to assess and ensure the safety of the infant.                                                                                                             

A joint supervisor staffing must take place between the supervisor for the worker assigned the NCA and the supervisor for the alternative care worker 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 the system of record (FACES). 

The I/A worker assigned the NCA will be responsible for completing the Newborn Crisis Assessment Tool (NCAT) and other tasks as described in

• Family Support Team (FST) Meeting: The worker assigned the NCA will request a Family Support Team (FST) meeting, that should 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. 
• Judicial and Juvenile Office Notification: The AC worker must notify the Juvenile Officer and the court that has jurisdiction of the siblings, of the infant’s birth as soon as practicable and feasible and ensure the court is notified of the outcome of the Juvenile Office referral made by the NCA worker. DLS may assist to determine the best manner to notify the court (e.g., filing a memo, including in a court report, or notifying the court verbally in a hearing).
• Guardian ad Litem (GAL) and Court Appointed Special Advocate (CASA) Notification: The AC worker must notify the GAL and CASA of the infant’s birth as soon as practicable and feasible. Section 210.160 RSMo mandates the GAL and CASA have access to all records relating to the child or the child’s family members.

Note: If at any time the infant is placed in the legal custody of Children’s Division, all court orders and Children’s Division policies related to children in CD custody should also be followed.

 

4.6.6.3 Infants Remaining in the Home

If through the NCA and JO referral processes it is determined the infant can safely remain in the parental home, the AC worker must ensure the infant’s safety and wellbeing during every interaction.

Should the parent prevent CD from conducting a thorough safety assessment by denying access to the infant, the infant’s sleeping space or the home, a supervisor should be contacted immediately and a JO referral should be made. All information surrounding the attempted safety assessment and parental refusal should be thoroughly documented in the system of record. Seek DLS consultation if needed.   

During each visit to the family home the AC worker must:

1. Ensure the immediate safety of the infant.
2. Complete a thorough assessment of the infant and family.

A thorough assessment includes, but is not limited to:

Assessment of Physical Safety & Parental Capacity

• Structured Decision Making® (SDM) Safety Assessment/Reassessment: Complete SDM safety assessments and reassessments as outlined in CWM 1.5.4 Structured Decision Making ®(SDM) Safety Assessment.
• Safe Sleep Environment: Education on safe sleep practices, utilizing the Safe Sleep Flyer (CD-278) and Safe Sleep Discussion Resource Guide (CD-278a). Engaging the family in safe sleep conversations are vitally important and should occur during every visit to the home.
• Home Environment: Determine if additional items are needed to properly care for the infant. Provide resources, as available, to obtain such items. Assess the physical environment to ensure it is safe for an infant. Address and resolve any safety concerns.
• Infant’s Physical Health: Observe and discuss the infant’s physical health, including feeding schedules and amounts, weight, medical appointments, and immunization schedules. Request parental consent to obtain records and/or verification of the child’s health and developmental progress. Request and review records to verify the child’s health needs are being met. Identify any needs and services to meet those needs.
• Parents’ Physical, Mental, and Emotional Health: Observe and discuss the parents’ physical, mental, and emotional condition. Inquire about scheduled or needed healthcare appointments. Discuss how any concerns may impact the health and/or care of the infant and develop a plan for support, taking into consideration the roles of their safety and support network.
• Plan of Safe Care (POSC): A POSC is developed when infants are affected by prenatal substance exposure to engage the parents, support persons, and service providers to strengthen the family, ensure the infant’s safety, and promote their well-being.
  • If substance use is a factor, the Investigations and Assessment (I/A) worker will have completed a POSC with the family using the Newborn Crisis Assessment Tool (NCAT). The AC worker should review any existing POSC to ensure it is being utilized and continues to meet the family’s needs.
• Family Dynamics & Culture: Discuss family dynamics, relationships, and culture. This should include how the birth of the infant impacts the daily lives of the parent(s) and other family members, including the children in AC. The Culturagram (CD-14F) may be used to develop a better understanding of the family’s needs and strengths, and to plan for appropriate interventions at the individual, family, and community levels.

Assessment of Formal and Informal Supports

• Natural Supports: Assist the family in identifying appropriate supports available to them. Explore the role and involvement of all parents, living in or outside the infant’s home, and the extended family and friend network. If the family does not have a strong safety network or support system in place, make efforts to support the family in this exploration, outreach, and dialogue. This may include use of a Genogram (CD-14G), Eco-map (CD-14H), or other engagement tools.
• Community Resource Providers: Discuss services and resources the family is currently utilizing. Determine if additional services are needed. This may include referrals to Special Supplemental Nutrition Program for Women’s, Infants and Children (WIC), Family Support Division (FSD) programs, Cribs for Kids, Parents as Teachers, Early Head Start, etc.
• Home Visiting referral: Explain Home Visiting services to the family. Encourage the family to participate in services and utilize the Coordinated Referral and Intake System (CRIS) to complete an online referral with the parent. This should be done pre-birth when possible.
• Intensive Family Reunification Services (IFRS) referral: IFRS may be appropriate when the children in AC may be starting Trial Home Placement in the very near future. IFRS can provide additional support for the children’s return and incorporation of the infant into the family.

 

4.6.6.4 Safety Concerns Post-Birth

Upon observing or learning of a safety concern, the AC worker will take immediate action to address and rectify the safety concern. 911 should be called if the infant requires immediate medical attention.

A supervisor should be contacted immediately and before leaving the home, if the parent is not willing or able to rectify the safety concern, or anytime further guidance is needed. The supervisor should assist in determining what actions should be taken, such as, but not limited to implementing a safety plan, calling law enforcement or requesting custody of the infant.

Children’s Division team members are required by law to immediately report to CANHU any reasonable cause to suspect a child has been or may be subjected to abuse or neglect, or any observation of a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect.

Once the safety of the infant has been secured, the AC worker should notify the Family Support Team of the safety concern and all actions taken to ensure child safety.

Signs and Symptoms of Withdrawal

When babies are exposed to drugs in the womb, they can experience physical withdrawal after birth. This is known as Neonatal Abstinence Syndrome. Signs and symptoms of withdrawal are dependent on the drug the infant was exposed to and how the drug was used during pregnancy. For more information, including a description of typical signs of withdrawal, see Stanford Medicine’s Neonatal Abstinence Syndrome article.

Any signs of withdrawal should be communicated to the infant’s medical provider. The AC worker should assist the parent in immediately contacting the appropriate medical provider. If the parent does not contact the medical provider, the AC worker should make the notification to the medical provider and report the information to CANHU.

The medical provider should be contacted immediately if the substance exposed infant:

• is not eating,
• has diarrhea or is vomiting,
• cannot be calmed down, or
• has worsened signs of withdrawal.

911 should be called if the infant requires immediate medical attention.

 

4.6.6.5 Contact and Documentation Requirements When the Infant Remains in the Parental Home

Initial Contact:             Within 2 business days after the infant’s discharge from the hospital, the AC worker or service worker should complete a home visit with the members of the infant’s household. The worker completing the NCA may conduct this home visit in lieu of the AC worker/service worker, if both workers agree to such an arrangement, or they may conduct a joint home visit. The worker should observe the infant’s sleep environment to ensure it is safe.

Months 1-3:                During the first 3 months after the infant’s discharge from the hospital, the AC worker should complete a home visit with the members of the infant’s household and observe the infant and their sleep environment a minimum of 2 times per month. These home visits are in addition to the initial contact. Both announced and unannounced visits should be utilized.

Monthly Ongoing:         After the first 3 months following the infant’s discharge from the hospital, the AC worker should complete a home visit with the members of the infant’s household and observe the infant and their sleep environment a minimum of once per month.  Both announced and unannounced visits should be utilized. Home visits should continue until case closure.

If needed, see CWM 4.11.5 Service Worker Requests

Documentation

Prior to the infant’s birth, document all conversations and activities in the existing AC case.

After the infants’ birth, add the infant as a case member to the existing AC case.

If the infant remains in the legal and physical custody of a parent, document activities related to the infant in the existing AC case. If information exists that is specific to parties unrelated to the siblings’ AC case, a Family Centered Services (FCS) case should be opened to document information for those individuals (e.g., the infant has a different father than the AC siblings).

If the infant is placed in the legal custody of CD, but remains in the parental home, an FCS case should be opened, and documentation should occur in the FCS case. Refer to CWM 4.10 Case Management Activities for additional case opening details.

 

4.6.6.6 Protected Health Information & Parental Consent

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 individually evaluated, 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.

Protected Health Information (PHI)

The Health Insurance Portability and Accountability Act (HIPAA) protects an individual’s Protected Health Information (PHI), ensuring it is kept private and secure from unauthorized access or disclosure. This includes verbal disclosure, sharing of physical records, electronic data (ePHI), and billing information. It also gives individuals rights to view and control their health information and sets rules for how providers can use and share the information. 

Protected Health Information (PHI) includes any combination of health information that can identify the individual (e.g., the individual’s name combined with their diagnosis or treatment plan, health status, test results, healthcare services, date of birth, contact information, SSN, medical record number, images, fingerprints, or any other unique identifying number or characteristic.).  

To receive or release PHI utilize one of the following releases of information:

• Authorization for Release of Medical/Health Information (SS-6)

Autorización Para Liberar Información Médica/de Salud (SS-6 Spanish) 

• Authorization For Disclosure of Confidential Information (MO 886-4596)

PHI: Parent/Guardian 

When a mother with children in CD custody becomes pregnant or gives birth to another child there may be a need to obtain or disclose PHI pertaining to her pregnancy or the birth of the child. Anytime the AC worker is unsure whether necessary authorization to obtain or release PHI exists, they should consult with the assigned Division of Legal Services (DLS) attorney. If questions remain, the AC worker or attorney should contact the privacy officer.

Receiving Parent PHI 

To receive a parent’s PHI from any individual or entity who is not the parent, the worker must first obtain a signed Release of Information from the parent. This authorizes CD to receive and hold that information or record. This does not authorize distribution of that information, unless a subpoena, court order, or statute allows for the release.

Sharing Parent PHI  

A parent can provide their own PHI to individuals without signing a Release of Information.  The worker or others may ask the parent about their PHI, including substance use, treatment attendance/progress, diagnosis, services, test results, etc. The parent may choose to provide the information or may decline.

To share a parent’s PHI with any individual or entity, the worker must first obtain a signed Release of Information from the parent, unless a subpoena, court order or statute allows for the release. A signed Release of Information authorizes CD to distribute verbal and written information as specified on the release and only during the time-period specified.  

Substance Abuse Treatment Records

CD team members should pay close attention whenever handling information or records relating to a parent’s substance use. Federal law provides special protections to treatment, diagnosis, or referral records produced by federally assisted substance use disorder programs (sometimes called “part 2 programs”). Any substance abuse treatment program that receives any form of assistance or approval from the federal government – including non-profit status – is considered “federally assisted” under this rule. Most substance abuse treatment programs staff will encounter are part 2 programs.

This does not mean every record relating to or mentioning substance abuse gets special protection. Records produced by something other than a substance abuse treatment program, are subject only to the ordinary HIPAA protections discussed in the previous section. Common examples would be emergency room records, labor/delivery records, records from a primary care provider or a drug test result produced by a lab that is not part of a treatment program.

When CD team members are dealing with records that are from a substance abuse treatment program, staff should ensure the proper authorization has been provided.

• The SS-6 form utilizes an “opt-out” provision for substance abuse treatment records stating “If you want to restrict this authorization to not include alcohol and drug abuse treatment records, please initial the following box”. When a parent initials the opt-out box, information related to substance use may not be obtained or released.
• The MO886-4596 form uses an “opt-in” provision for treatment records. If this form is used, staff ensure the parent has signed and dated the “Authorization to Disclose Substance Abuse Treatment Information” section. If this section is signed and dated the substance use information may be obtained or released.

If a CD team member has additional concerns or questions about substance abuse treatment records, they should consult with the assigned Division of Legal Services (DLS) attorney. If questions remain, the alternative care worker or attorney should contact the privacy officer.