Texas Child Protective Services Drug and Drug Testing Policy

(Knowledge is power)

Source: TDPRS Substance Abuse Policy

1923 Testing for Substance Abuse

1923.1 Detection Periods for Substance Abuse

For detection periods, see Appendix 1922.1: Detection Periods for Abused Substances.

1923.2 Diluted Samples Obtained During Testing

A diluted sample indicates that a client drank a large amount of water at some time before the drug test.

When the lab indicates that a sample is diluted, the caseworker can take one the following actions to arrive at a conclusion about the client’s use:

• Have the client retested

• Request a different type of testing, such as requesting a hair follicle test instead of a urine test

• Rely on credible evidence obtained through observation, information from collateral sources (such as a teacher, neighbor, or family doctor), and the case history

1923.3 Instant (Swab) Tests and Court Hearings
An instant test is a swabbing of a client’s oral fluids. The test is performed by a caseworker to test for recent drug use. If possible, the test results are confirmed by a laboratory.

Using the Tests in Court

Before presenting the results of instant swab tests as evidence in court, the caseworker must obtain confirmation from a laboratory.

1923.4 Using Acceptable Contractors to Obtain Test Results

DFPS accepts lab test results from physicians, hospitals, the legal system (such as the adult probation department), and providers of substance abuse treatment in order to assess safety and to assess the need for services and treatment.

1923.5 Frequency of Random Substance Abuse Testing

In general, the caseworker may conduct random drug tests when substance abuse laboratory testing is allowed under 1920 Substance Abuse Testing; that is, when:

• a case is scheduled for closure;

• reunification of the child with his or her family is contemplated;

• there are changes in the parent’s appearance, behavior, or affect;

• new information is received about possible substance abuse;

• the client has terminated substance abuse treatment;

• the client shows signs of returning to seeking and using drugs, including associating with former friends and family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol;

• the client refuses to create a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses);

• the client minimizes or denies seeking and using drugs seeking and after test results come back positive;

• there are signs that abstinence is being threatened; for example, when a client increases the amount of alcohol consumed or begins to smoke cigarettes frequently to relieve anxiety;

• the client has made minimal or no effort to mitigate the substance abuse related problems that led to abuse and neglect;

• the client is not involved in substance abuse treatment or aftercare, even though it was recommended; and

• the regional substance abuse specialist recommends testing.

Hair Follicle Testing

The caseworker determines the frequency with which random hair follicle testing may be conducted, by following regional protocols.

1923.6 Situations Not Appropriate for Drug Testing

It is not appropriate for a caseworker to arrange for drug testing when a parent is:

• actively involved in substance abuse treatment and the treatment provider conducts random testing that is based on laboratory confirmation.

• randomly tested by another entity, such as a probation department or drug court, and the test is confirmed by a laboratory. The caseworker must check into the frequency of testing by the other entity, before random testing is discontinued by CPS.

1923.7 Discontinuing Drug Testing

The caseworker must discuss with the supervisor and the client’s treatment provider when contemplating discontinuing routine drug testing.

The discontinuation or modification of routine drug testing may be considered when:

• A parent does not exhibit substance seeking and using behaviors (for example, when associating with former friends or family members who use drugs; keeping drug paraphernalia in the home; or making statements minimizing or denying having a problem with drugs or alcohol); and

• The parent has a consistent pattern of negative tests results.

1923.8 Assessing Test Results or Accepting an Admission

Positive Result

The caseworker must assess a positive drug test result in relationship to the child’s safety and risk. The result must be discussed with the parent in a timely manner.

If a parent with a positive drug result is not engaged in substance abuse treatment and is actively parenting a child, the caseworker refers the parent to:

• a provider of outreach, screening, assessment, and referral (OSAR) services or

• a provider of substance abuse treatment.

The threshold that makes a referral appropriate is based on the definition of a child not being safe.

That is, a child is not safe when:

• threats or dangers exist in the family that are related to substance use;

• the child is vulnerable to such threats; and

• the parent who is using substances does not have sufficient protective capacities to manage or control threats.

Client Admission

A client’s verbal or written admission is accepted as a positive result of drug use; however good casework practice calls for getting the client to sign a statement of use.

Testing to Rule Out Under-Reporting

If a client admits to drug use, is not engaged in treatment, and is actively parenting children, the caseworker may consider referring the client to a substance abuse provider for screening, assessment, or treatment.

Referral may be necessary because clients sometimes under-report drug use or do not admit to all of the substances that they have used.

Clients likewise may under-report:

• the frequency with which they use dugs,

• the quantity of drugs they use, and

• the amount of money they spend on the drugs.

Negative Result

When the result of a parent’s drug test is negative, the caseworker:

• notifies the parent about the result in a timely manner; and

• encourages the parent’s abstinence and provides positive feedback.

Refusal to Test

When testing is appropriate under 1920 Substance Abuse Testing, but the client refuses to take a drug test, the caseworker must document the refusal to be tested.

If a parent refuses to take a drug test or refuses to allow a child who is an alleged perpetrator to be tested, the caseworker consults with the supervisor in a staffing meeting. The supervisor may recommend legal intervention, if the evidence raises concern for the child’s safety.

For cases under court jurisdiction, the caseworker must notify the judge and attorneys about the client’s refusal to test.

When testing is appropriate under 1920 Substance Abuse Testing, the caseworker must document any prescribed medication that the client is taking.

The documentation may be made by:

• completing a regional form; or

• entering the details in the Contact Narrative in the IMPACT system.

The caseworker must share the information about the client’s medication with the lab’s medical review officer (MRO).

1924 Special Situations Related to Substance Abuse

1924.1 Methadone and Prescription Medication

Methadone

If the parent tests positive for methadone, the caseworker:

• obtains a release (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services) from the parent;

• verifies with the methadone clinic, that the parent has a prescription for methadone and is taking methadone as prescribed; and

• assesses the effect that the methadone dosage has on the parent’s ability to provide consistent and safe supervision of the children.

Prescription Medicine

Similar to methadone, the caseworker must assess the effect that prescription medications have on a parent’s ability to provide supervision and to keep children safe.

To determine whether the client is taking his or her medication as prescribed, the caseworker must check with the client’s medical provider.

For the caseworker to obtain the information from the medical provider, the client needs to sign a consent-to-release form (Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services).

If the client refuses to sign the release form, the caseworker consults with the supervisor about whether to request legal intervention.

1924.2 The Infectious Client

If the caseworker is concerned that a client may have an infectious disease, the caseworker, with the supervisor’s approval, refers the client to a local drug-testing facility for a urine test in lieu of an oral test.

Testing Within 48 Hours

The client must be tested within 48 hours after the contact with the caseworker.

1924.3 Drug Use During a Parent-Child Visit or FGDM Conference

A court order supersedes the following DFPS policies.

Parent-Child Visit

If a parent appears to be under the influence of a controlled substance and or alcohol, the parent-child visit must not occur.

Family Group Decision Making (FGDM) Conferences

A parent or participant who is visibly intoxicated during a family group decision making (FGDM) conference, must be excused from the conference.

The caseworker does not administer an oral test during the FGDM conference. Any required testing occurs at the end of the meeting and preferably at a location away from the FGDM immediate site.

For policy on the testing of youth, see 1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol.

The existence of a positive drug result in the case record does not automatically exclude a parent from visiting with the child or attending a FGDM. The caseworker needs to weigh the benefits of the visit or attendance when confronted with a positive drug reading in the case record.

If the child will not be in danger, the visit or participation may be allowed.

1924.4 The Court Testimony of the Medical Review Officer

Because of the high costs, testimony provided by technicians, medical review officers (MRO), or other personnel employed by drug testing facilities is reserved for extreme circumstances; for example, parental termination hearings in substitute care cases when a judge rehuttoquires testimony in person.

Alternatives to consider before requesting court room testimony from a representative of a drug testing laboratory include:

• depositions at locations near the drug testing laboratory; and

• testimony provided via teleconference.

If DFPS concludes that court room testimony is necessary from a representative of a drug testing laboratory, the DFPS region requiring the testimony:

• negotiates payment rates;

• negotiates travel expenses;

• renders payment for court-related services; and

• renders payment for testimony provided by a representative of a drug-testing laboratory.

1930 Casework Practice for Substance Abuse Cases

1931 Overview of Casework

Practice for Substance Abuse Cases
1931.1 The Definition of a Drug

The word drug, as used in this policy, refers to:

• controlled substances;

• prescriptions;

• over-the-counter medications; and

• alcohol.

1931.2 Obtaining Diagnostic Classifications From Professionals

When a client appears to be using drugs, the caseworker refers the client to professionals for in depth screening, assessment, or treatment.

The caseworker does not make any diagnostic classifications regarding the criteria of drug or alcohol use by the client. Classifications are made by licensed professionals.

For a summary of the criteria, see Appendix 1931.2: Criteria for Diagnosing Substance Abuse.

1931.3 Guiding Principles of Drug Testing

Administering a drug test does not change the protocols for conducting an investigation or for performing casework. The caseworker does not rely solely on a drug test to arrive at a conclusion or make a decision in a case.

The caseworker considers the entire case, including:

• both the negative and positive results of drug tests; and

• all other evidence, such as statements from collateral witnesses (such as teachers, neighbors, and family doctors), the effect of any drug use on the children in the case, and the ability of the parent to protect the child.

1931.4 Marijuana Policy

In compliance with Texas law and the schedules of controlled substances required by the Department of State Health Services, DFPS considers marijuana a Schedule I Controlled Substance that is illegal.

Medical Marijuana

The State of Texas and DFPS do not recognize the use of medical marijuana, whether taken in pill form or by smoking. DFPS views marijuana as analogous to any other illegal substance or the use of alcohol as it relates to a child’s safety.

1931.5 Determining Safety and Risk When Marijuana, Other Substances, or Alcohol Are Present

Caseworkers need to determine whether the use of marijuana, other illegal substances, or alcohol:

• puts a child in situations of danger or harm; or

• places the child at risk for abuse or neglect.

Immediate Safety

In assessing the child’s immediate safety, the caseworker assesses the following:

• Parental behavior – For instance, erratic behavior that makes the parent appear unable to protect the child, or the inability to separate reality from hallucinations.

• Physical signs of impairment – For example, in the case of marijuana use, the physical signs of impairment could include altered perception, dilated pupils, lack of concentration and coordination, craving for sweets, increased hunger, laughter, slowed thinking, slowed reaction time, and respiratory infections (The caseworker may also notice the smell of burned rope. Physical impairment indicates that threats are present, the child is vulnerable, and the parent does not have sufficient protective capacities to deal with the threats to the child’s safety. For more information, see, Appendix 1931.1: Physical Signs and Symptoms of Drug or Alcohol Use.

• The lack of a sober, protective parent present who possesses sufficient protective capacities to mitigate threats.

• A child’s age and level of vulnerability as a measure of the extent to which threats or risk of harm are present.

• Whether the basic needs of child are being met; for example, determining whether the child is so severely neglected due to the parent’s substance use or abuse that the child needs immediate medical attention.

• Accessibility to substances – A child’s accessibility to marijuana, other substances, prescriptions drugs, or alcohol makes the child vulnerable to threats or dangers.

• physical safety – The extent to which the living environment creates the condition for threats or harm to the child; for example, a child living in a home where Methamphetamine is cooked.

Risk in Foreseeable Future

To assess the risk of abuse and neglect in the foreseeable future, if CPS were no longer involved, the following tasks are completed by the caseworker:

• Conduct a full risk assessment

• Talk to collaterals, especially school officials or child care staff

• Assess for prior CPS history, criminal history, and substance abuse history

• Assess for prior or current participation in treatment programs

• Review mental health, psychiatric history, or both

• Determine when the parent last used a substance

• Ask the parent about the friends and family members that visit the home in relationship to their drug use and history

• Ask about the presence of a sober protective caregiver who has sufficient protective capacities to manage threats

1932 Screening and Assessing for Substance Abuse

1932.1 Screening for Substance Abuse

Questionnaires

Using a simple screening questionnaires, the caseworker determines whether a parent is in need of further screening, assessment, or treatment for substance abuse.

The following questionnaires are easy screenings for the caseworker to administer:

• CAGE(Cut Down, Annoyed, Guilty, and Eye-Opener)

• UNCOPE (Using, Neglected, Cut Down, Objected, Preoccupied, and Emotional)

Considerations

The caseworker also considers the following as further intervention when a client indicates that he or she is using marijuana or other controlled substances, or is using alcohol in a way that threatens the child’s safety:

• Observation

• Medical, criminal, and substance abuse histories

• Collateral reports

• Examination of the living environment

• Information from the case record

Timeframe

A screening for drug or alcohol use can be conducted in any stage of the case.

1932.2 Fetal Alcohol Spectrum Disorder

When appropriate, the caseworker may administer either of the following screening questionnaires when interviewing a pregnant mother who is alleged to be drinking alcohol while pregnant:

• T-ACE (Tolerance, Annoyance, Cut Down, and Eye-Opener)

• TWEAK (Tolerance, Worry, Eye-Opener, Amnesia, and Cut Down)

The T-ACE and the TWEAK questionnaires help identify the risk of alcohol use during pregnancy. Drinking alcohol during pregnancy can damage the embryo or fetus.

If the questionnaire indicates that a pregnant mother is drinking alcohol, the caseworker refers her to a health clinic or physician.

1932.3 Drug Use Outside of the Home

A caseworker considers a parent’s drug use as he or she would any other evidence in a case; that is, the caseworker considers it along with all other available evidence when:

• making a disposition;

• evaluating a parent’s need for treatment; or

• assessing the safety of a child.

Whether the drug use occurs inside or outside the home must not automatically lead the caseworker to one conclusion or another. Each case must be reviewed and addressed individually; for example, whether the parent tests positive for or admits to using marijuana, other illegal substances, or alcohol either outside of the home or outside of the presence of the children (for example, if the parent smoked marijuana at a party that was held away from the home).

In arriving at a disposition, the caseworker follows the statutory definitions of abuse and neglect. It is the effect that the marijuana smoking, drug use, or alcohol use have on the child and the child’s safety that guides the disposition, rather than purely the parent’s use of the substance.

To arrive at a disposition, the caseworker takes into account that a child’s safety is based on:

• the child’s vulnerability;

• the threats of danger within the family; and

• the capacity of a protective caregiver.

1940 Establishing Protective Measures When a Child Is Threatened by Substance Abuse

When a child’s safety is threatened by a client’s use of marijuana, other substances, or alcohol, or when there is a risk that the child’s safety could be threatened, the caseworker puts protective measures into place.

The table below lists some of the protective measures the caseworker can consider:

Protective Measure

Interventions

Related Definitions

Ensure the child’s immediate safety

• Safety assessment

• Safety plan

• Parental-child safety placement (voluntary placement by the parent, as opposed to by a court order)

• Conservatorship removal

Safe child:

Vulnerable children are safe when there are no threats of danger within the family or when the parents possess sufficient capacity to manage threats and protect the child.

Help client achieve and maintain abstinence

• Random drug testing

• Physician-prescribed medications to treat a drug or alcohol addiction

• Detoxification

Refraining from the use of alcohol or other drugs.

(Abstinence from alcohol applies to parents who have endangered a child’s safety when drinking)

Develop a relapse safety plan

• Network of abstinent and sober friends and family members

• Identified friend or family member to protect the child

Plan to provide safety for the child, if the parent contemplates a relapse or experiences a relapse

Seek judicial oversight

• Motion to participate

• Order in aid of investigation

• Family treatment drug court

• Petition for temporary managing conservatorship

Involvement of the court to mitigate problems of substance abuse and child safety

Develop reliable sources of support

• TANF

• Protective day care

• Medicaid

• Employment or job training

• Food stamps

• Housing or public housing

Having tangible resources that enable a parent to recover, or to improve enough to meet the parent’s and family’s financial and basic needs.

Guide parenting and child development

• Parenting class

• Participation in ECI (Early Childhood Intervention)

Having knowledge about parenting, child development, and alternative forms of discipline

1950 Newborns, Children, and Youth Who Are Exposed to Drugs or Alcohol
1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol

1951.1 Youth Who Are Not in DFPS Conservatorship and Are Not Unemancipated

Unless legally married or otherwise legally emancipated, a youth is not considered an adult until the age of 18, even if the youth is a parent.

Guiding Principle

Court orders requiring drug testing supersede the guiding principle below.

When a caseworker becomes aware that a child or adolescent is smoking marijuana, using drugs, or drinking alcohol, the caseworker treats the situation as a medical concern that must be addressed by the parent, just as any other medical concern must be.

Treating the situation as a medical concern assumes that a child using drugs is in need of protection. The intent is to:

• rule out any medical complications associated with drug exposure; and

• give the parent an opportunity to take ownership for the issues that may have led the child to use and help the child obtain any necessary treatment.

The caseworker does not administer drug tests to the child. If the allegation involves a child age 10 or older as an alleged perpetrator, the caseworker obtains written consent from the parent to send the child to a drug testing laboratory.

If the parent refuses to give written consent for the testing, the caseworker discusses with his or her supervisor the possibility of seeking legal intervention.

Parent Obtains Testing and Treatment for the Youth

The caseworker seeks to empower and encourage the parent to take responsibility to obtain testing, screening, assessment, or treatment for the child or adolescent, if it appears necessary.

Necessity is based on credible evidence that the youth might be using drugs or drinking alcohol; for example, a parent stating that a child or youth has been exposed to drugs or alcohol. As appropriate, the worker assists the parent in accessing substance abuse services through a medical clinic or provider, such as a primary care physician, health clinic, or emergency room.

If the medical provider recommends treatment, the caseworker assists the parent in accessing services in the community. Or, the worker refers the parent and child to a provider of outreach, screening, assessment, and referral (OSAR) services. The youth must be age 13 or older to be referred to OSAR. See 1912 Referring Clients to DSHS-Funded Substance Abuse Treatment.

The parent has the right to purchase over-the-counter drug tests as an initial step in arranging for the youth to be seen by a medical provider or OSAR.

1951.2 Children and Adolescents in DFPS Conservatorship

Guiding Principle

Due to the physical and psychological harm drug use may cause a child or youth, CPS practice is to take a medical approach when addressing the issue.

If a caseworker or medical consenter suspects that a child or youth may be using drugs, the caseworker or medical consenter may have the child tested only by a medical provider.

The caseworker and medical consenter:

• must not administer drug tests to the youth; and

• must not give permission for the youth to be tested initially by any entity that is not a medical provider.

Exception

If a youth is under the supervision of Texas Juvenile Justice Department (TJJD) or the county juvenile probation department, the youth can be tested for drugs by the juvenile system.

Process

To have a youth tested by a medical provider, the caseworker the medical consenter, makes an appointment with the youth’s health care provider or primary care physician (PCP), just as he or she would if the youth were sick.

As in any medical emergency situation, if the youth appears to require immediate medical care, the youth must be taken to an emergency care facility. The caseworker or medical consenter then informs the health care provider or the PCP about the concern for the youth’s possible use or abuse of drugs or alcohol. The health care provider or PCP may refer the youth to a substance abuse professional.

At the time the youth is suspected to be using or abusing drugs or alcohol, the caseworker:

• collaborates with the regional DFPS substance abuse specialist and the DFPS well-being specialist to coordinate the most appropriate services for the youth’s individual needs;

• Follow the recommendation of qualified professionals in addressing the youth’s substance abuse issues, the caseworker incorporates the recommendations into the child’s plan of service and follow the treatment recommendations of the doctor or qualified professional, which may include residential treatment and rehabilitation services. When appropriate and available, the youth’s treatment services must be located within the youth’s community.

1951.3 Youth in Extended Care or Return to Care

Youth who are 18 years of age or older and are receiving extended care or return-to-care services are considered young adults. Young adults are subject to the drug testing policy for adults. While in a DFPS placement, the young adult must abide by the voluntary agreement that he or she signed to remain in conservatorship.

If it is suspected that a young adult is abusing substances, the caseworker:

• makes the appropriate referrals to services to assess whether substance abuse treatment is needed; and

• encourages the young adult to seek services.

1952 Newborns Exposed to Drugs or Alcohol
1952.1 Safety Plan for a Substance-Exposed Newborn

An allegation that a newborn has been exposed to drugs or alcohol could result in DFPS filing legal paperwork to be named the newborn’s temporary managing conservator.

The tasks the caseworker must accomplish in an open case are explained in the table below:

Stage of the Case

Task the Caseworker Completes

Investigation

Complete a risk assessment within 30 days of the birth of the newborn.

FBSS Home Visit

See 3000 Family Based Safety Services to determine the frequency of home visits.

Family Service Plan (FBSS or CVS)

For the timelines within which to complete or update a family service plan, see:

3000 Family Based Safety Services; and

6000 Substitute-Care Services.

During a home visit

Provide the parent with available information about:

• infant care and development,

• safe sleep precautions,

• SIDS reduction, and

• substance abuse

• parenting

• Early Childhood InterventionExternal Link (ECI) program of Texas Health & Human Services (HHS).

At any stage that is appropriate

Schedule a Family Team Meeting or a Family Group Conference.

See:

1121 Family Group Decision-Making (FGDM)

2440 Family Team Meetings

6251 Overview of Permanency Planning Meetings

Appendix 1100-1: Roles and Responsibilities of Family Group Decision-Making (FGDM) Staff

If services beyond the investigation are provided

Consider referring the mother (or the mother and newborn) to an inpatient substance abuse program.

Specify whether participation is voluntary or is based on CPS holding an order of Temporary Managing Conservatorship.

Note the referral in the family’s service plan.

Consider case for Family Drug Treatment Court if available in your region. See Appendix 1961: Family Drug Treatment Courts (FDTCs) for more information.

1960 Treatment for Drug and Alcohol Abuse
1961 Treatment Options for Drug and Alcohol Abuse

Regardless of the nature of treatment, caseworkers need to make appropriate referrals when drug use is present. See Appendix 1960: Treatment Options for Substance Abuse.

All treatment must meet the individual needs of each client. In selecting the treatment option, the caseworker considers:

• the type of substance use,

• progression of that use,

• prior attempts at treatment,

• drug use experience, and

• client’s motivation for treatment.

Clients respond differently to treatment. Treatment begins with abstinence; that is, refraining from alcohol or drugs that endanger a child’s safety and continues with a drug-free lifestyle. The longer the client is in treatment, the better the outcome for abstinence and a drug-free lifestyle, and the greater the chance that protective measures remain in place for the child’s safety.

1962 Education When Treatment Is Not Recommended by an OSAR Screener or Provider

If a service provider or screening substance abuse counselor does not recommend treatment for a client, and the caseworker is convinced (based on drug tests, or on information from collateral sources or the case record), that the client is in need of substance abuse services, the caseworker may consider:

• providing the client with substance abuse pamphlets and other educational materials about substance abuse;

• submitting the client to random drug tests; and

• referring the client to programs, such as Alcohol Anonymous or Narcotics Anonymous.

The caseworker may also appeal a denial. For more information about appealing a denial, see the regional substance abuse specialist. The CPS appeal process involving the OSAR can be found in Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services.

1963 When Treatment Is Unavailable, Resources Are Scarce, Waiting Lists Are Long, or the Distance Is Too Far to Travel

A lack of resources and other logistical circumstances may prevent a client from getting certain substance abuse services; however, the caseworker must not assume that there are no services that may be provided.

In such circumstances, while the caseworker cannot provide treatment, the caseworker:

• considers the options for intervention that areavailable to the client;

• works with the client to incorporate the options into an agreed-upon service plan; and

• obtains approval of the plan from the supervisor.

Developing the Substance Abuse Service Plan

In lieu of other resources, the caseworker may advise the client to take the following actions as part of the client’s substance abuse service plan:

• Join a community support group for people in recovery (for example, Alcoholic Anonymous or Narcotics Anonymous).

• Obtain a medical assessment by a health clinic or physician (for example to determine whether substance abuse has harmed the client’s health, or to see whether there is medication that can help the client remain abstinent).

• Pass random drug tests conducted by the caseworker.

• Develop a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses).

• Include protective measures in the client’s relapse safety plan. (See 1940 Establishing Protective Measures When a Child Is Threatened by Substance Abuse.)

• Read educational materials and handouts on substance abuse and recovery. (The following Web sites contain handouts and publications on substance abuse that the caseworker may share with clients.):

• Identify the triggers and actions needed to change past behaviors. (The following Web sites contain information on relapse prevention that the caseworker may share with clients):

• Self-report the days abstinent and the days monitored by a sober or abstinent family member.

• Obtain services at a mental heath clinic, if applicable.

• Self-report when recovery is threatened.

• Avoid the people, places, and things that can jeopardize abstinence and recovery (avoid situations, friends, family members, and locations that encouraged drug use in the past).

• Accept, at the insistence of the caseworker, that abstinence is the only acceptable behavior if the client is to be allowed to care for or be in the presence of his or her children; and that the client’s drug use has placed or places the children in danger.

1964 The Prevention and Early Intervention Program (PEI)

The goal of the Prevention and Early Intervention Program (PEI) is to preclude the involvement of CPS while providing services to families thereby preventing or removing conditions that could lead to child abuse and neglect.

PEI services are delivered to the client by local contractors throughout the state. When a caseworker believes that a family could benefit from services that would prevent or stop child abuse and neglect and the CPS case has been closed, a referral to PEI may be appropriate.

For the locations of PEI programs by county, see the DFPS intranet page on Prevention and Early Intervention.

1965 Indicators of Progress Made Toward Recovery

Recovery is a long process and, under the clauses of the Federal Adoption and Safe Families Act (P.L.105-89External Link), CPS’s involvement with a family is time limited; therefore a client’s caseworker and treatment providers must communicate frequently and remain cognizant of the time limits.

Indicators of progress that the caseworker can rely on in weighing the next step in the CPS case are whether the parent:

• attends and stays engaged in a substance abuse treatment program.

• participates in community recovery support groups, following the guidelines of 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous, and obtaining a sponsor, if applicable.

• achieves a period of abstinence.

• complies with the CPS service plan.

• complies with the CPS safety plan, if there is one.

• has developed a relapse safety plan. See 1966 Developing a Safety Plan in Case a Client Relapses.

• is achieving parenting goals.

• has established a pattern of negative results from drug tests .

• visits his or her children consistently and displays increased parental responsibility (if applicable).

• has changed past substance-abusing behaviors and has developed a network of sober, abstinent family members and friends.

• parent is employed (if applicable).

• has no new reports of criminal activity.

• has no new substantiated allegations of abuse and neglect that are related to substance abuse.

• takes prescribed psychotropic medications correctly (if applicable).

The key components of effective substance treatment in the CPS context are as follows:

• Maintaining abstinence

• Remaining involved in treatment or aftercare

• Acquiring and demonstrating parenting skills, including bonding with the children (for applicable parents).

• Mitigating the problems that led to the abuse and neglect that was caused by substance abuse.

• Developing a relapse safety plan.

1966 Developing a Safety Plan in Case a Client Relapses
CPS June 2010

Relapse is the return to the pattern of substance abuse or addiction, as well as the process during which indicators appear before the client’s resumption of substance use.

In the relapse safety plan the client spells out the steps he or she plans to take to ensure the safety of the children when relapse becomes an issue; for example, the client might state in the relapse safety plan that:

• he or she will place the children with CPS-approved family members or friends when experiencing a relapse; and

• the children will remain with the family members or friends until the client returns to abstinence and is once again engaged in treatment or aftercare services.

Any court orders supersede any actions stipulated by the client involving a voluntary caregiver in the relapse safety plan.

1960 Treatment for Drug and Alcohol Abuse
1961 Treatment Options for Drug and Alcohol Abuse

Regardless of the nature of treatment, caseworkers need to make appropriate referrals when drug use is present. See Appendix 1960: Treatment Options for Substance Abuse.

All treatment must meet the individual needs of each client. In selecting the treatment option, the caseworker considers:

• the type of substance use,

• progression of that use,

• prior attempts at treatment,

• drug use experience, and

• client’s motivation for treatment.

Clients respond differently to treatment. Treatment begins with abstinence; that is, refraining from alcohol or drugs that endanger a child’s safety and continues with a drug-free lifestyle. The longer the client is in treatment, the better the outcome for abstinence and a drug-free lifestyle, and the greater the chance that protective measures remain in place for the child’s safety.

1962 Education When Treatment Is Not Recommended by an OSAR Screener or Provider

If a service provider or screening substance abuse counselor does not recommend treatment for a client, and the caseworker is convinced (based on drug tests, or on information from collateral sources or the case record), that the client is in need of substance abuse services, the caseworker may consider:

• providing the client with substance abuse pamphlets and other educational materials about substance abuse;

• submitting the client to random drug tests; and

• referring the client to programs, such as Alcohol Anonymous or Narcotics Anonymous.

The caseworker may also appeal a denial. For more information about appealing a denial, see the regional substance abuse specialist. The CPS appeal process involving the OSAR can be found in Form 2062Word Document DFPS Release of Confidential Information to DSHS/Substance Abuse Services.

1963 When Treatment Is Unavailable, Resources Are Scarce, Waiting Lists Are Long, or the Distance Is Too Far to Travel

A lack of resources and other logistical circumstances may prevent a client from getting certain substance abuse services; however, the caseworker must not assume that there are no services that may be provided.

In such circumstances, while the caseworker cannot provide treatment, the caseworker:

• considers the options for intervention that areavailable to the client;

• works with the client to incorporate the options into an agreed-upon service plan; and

• obtains approval of the plan from the supervisor.

Developing the Substance Abuse Service Plan

In lieu of other resources, the caseworker may advise the client to take the following actions as part of the client’s substance abuse service plan:

• Join a community support group for people in recovery (for example, Alcoholic Anonymous or Narcotics Anonymous).

• Obtain a medical assessment by a health clinic or physician (for example to determine whether substance abuse has harmed the client’s health, or to see whether there is medication that can help the client remain abstinent).

• Pass random drug tests conducted by the caseworker.

• Develop a relapse safety plan (see 1966 Developing a Safety Plan in Case a Client Relapses).

• Include protective measures in the client’s relapse safety plan. (See 1940 Establishing Protective Measures When a Child Is Threatened by Substance Abuse.)

• Read educational materials and handouts on substance abuse and recovery. (The following Web sites contain handouts and publications on substance abuse that the caseworker may share with clients.):

• Identify the triggers and actions needed to change past behaviors. (The following Web sites contain information on relapse prevention that the caseworker may share with clients):

• Self-report the days abstinent and the days monitored by a sober or abstinent family member.

• Obtain services at a mental heath clinic, if applicable.

• Self-report when recovery is threatened.

• Avoid the people, places, and things that can jeopardize abstinence and recovery (avoid situations, friends, family members, and locations that encouraged drug use in the past).

• Accept, at the insistence of the caseworker, that abstinence is the only acceptable behavior if the client is to be allowed to care for or be in the presence of his or her children; and that the client’s drug use has placed or places the children in danger.

1964 The Prevention and Early Intervention Program (PEI)

The goal of the Prevention and Early Intervention Program (PEI) is to preclude the involvement of CPS while providing services to families thereby preventing or removing conditions that could lead to child abuse and neglect.

PEI services are delivered to the client by local contractors throughout the state. When a caseworker believes that a family could benefit from services that would prevent or stop child abuse and neglect and the CPS case has been closed, a referral to PEI may be appropriate.

For the locations of PEI programs by county, see the DFPS intranet page on Prevention and Early Intervention.

1965 Indicators of Progress Made Toward Recovery

Recovery is a long process and, under the clauses of the Federal Adoption and Safe Families Act (P.L.105-89External Link), CPS’s involvement with a family is time limited; therefore a client’s caseworker and treatment providers must communicate frequently and remain cognizant of the time limits.

Indicators of progress that the caseworker can rely on in weighing the next step in the CPS case are whether the parent:

• attends and stays engaged in a substance abuse treatment program.

• participates in community recovery support groups, following the guidelines of 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous, and obtaining a sponsor, if applicable.

• achieves a period of abstinence.

• complies with the CPS service plan.

• complies with the CPS safety plan, if there is one.

• has developed a relapse safety plan. See 1966 Developing a Safety Plan in Case a Client Relapses.

• is achieving parenting goals.

• has established a pattern of negative results from drug tests .

• visits his or her children consistently and displays increased parental responsibility (if applicable).

• has changed past substance-abusing behaviors and has developed a network of sober, abstinent family members and friends.

• parent is employed (if applicable).

• has no new reports of criminal activity.

• has no new substantiated allegations of abuse and neglect that are related to substance abuse.

• takes prescribed psychotropic medications correctly (if applicable).

The key components of effective substance treatment in the CPS context are as follows:

• Maintaining abstinence

• Remaining involved in treatment or aftercare

• Acquiring and demonstrating parenting skills, including bonding with the children (for applicable parents).

• Mitigating the problems that led to the abuse and neglect that was caused by substance abuse.

• Developing a relapse safety plan.

1966 Developing a Safety Plan in Case a Client Relapses
CPS June 2010

Relapse is the return to the pattern of substance abuse or addiction, as well as the process during which indicators appear before the client’s resumption of substance use.

In the relapse safety plan the client spells out the steps he or she plans to take to ensure the safety of the children when relapse becomes an issue; for example, the client might state in the relapse safety plan that:

• he or she will place the children with CPS-approved family members or friends when experiencing a relapse; and

• the children will remain with the family members or friends until the client returns to abstinence and is once again engaged in treatment or aftercare services.

Any court orders supersede any actions stipulated by the client involving a voluntary caregiver in the relapse safety plan.

1970 Drug-Endangered Children
1971 Drug Raids to Protect Drug-Endangered Children

In compliance with the Memorandum of Understanding between DFPS and the Texas Alliance for Drug Endangered Children, the CPS caseworker’s role is to:

• respond to law enforcement, when notified about a drug-endangered child;

• accept control of the child from law enforcement or first responders taking control of a child must be consistent within the context of CPS general removal policies;

• arrange for appropriate decontamination;

• arrange for immediate and follow-up medical care;

• conduct an initial interview with the child;

• make placement decisions; and

• collaborate on an ongoing basis with law enforcement, medical personnel, and a criminal prosecutor.

See Appendix 1971: Protocol for Working With Drug-Endangered Children for more information on caseworker procedures for dealing with drug-endangered children.

1972 Safety Tips for Visiting Homes or Areas Where Substance Abuse Is Practiced

Visits to homes where marijuana, other controlled substances, and alcohol are present can present additional safety risks to caseworkers. In addition to the general precautions caseworkers need to take in making home visits, the following are precautions specific to the presence of substance abuse in the home:

If

a home is located in an area known for drug dealing …

before visiting the home:

• requests that a special investigator research, through law enforcement, the prevalence of criminal activity related to narcotics or violence that has taken place in the home; and

• requests that law enforcement officers assist when the caseworker goes to a home located in an area known for drug dealing.

one or both parents appear in the home to be intoxicated or incoherent …

• first ensures his or her own safety and the safety of the children;

• then calls law enforcement for assistance; and

• then calls the CPS supervisor for further guidance.

Considerations for Removal

A child is not removed simply because the parent is intoxicated. The caseworker weighs the following before deciding the action to take, when faced with an intoxicated parent:

• the child’s safety;

• the potential risk;

• the parent’s protective capacities; and

• CPS removal policies.

the caseworker suspects that he or she is in a home that is used as a drug factory, lab, or home where drugs are sold …

• calmly leaves the home; and

• calls law enforcement.

the caseworker observes drug use in the home …

does not take possession of the drug. CPS does not take possession of evidence. The caseworker calls law enforcement, if needed.

1973 Recognizing When a Caseworker Is Physically Exposed to Drugs

The caseworker needs to be familiar with some of the typical symptoms associated with drug exposure.

The symptoms the caseworker might experience if exposed to a drug substance are:

• shortness of breath;

• blue-colored skin;

• rapid breathing;

• anxiety;

• tightness in the chest;

• feeling fidgety; and

• pain when swallowing.

If the caseworker is exposed to a drug, he or she:

• seeks medical treatment, before taking any other steps; and then

• notifies his or her supervisor;

• completes, within one day of the incident, an Accident/Incident ReportExternal Link through the accessHR human resources system; and

• informs his or her physician about the suspected drug exposure.

Methamphetamine

If the caseworker suspects that he or she has been exposed to Methamphetamine, he or she contacts emergency medical personnel for decontamination and medical treatment.

1980 Assessing Substance Abuse

When assessing a client’s substance abuse, the caseworker does as follows:

• Assesses the nature of the client’s use (uses, abuses, is addicted, does not use)

• Assesses the effects of the client’s use on the client (physically, behaviorally, cognitively, socially, financially, and spiritually)

• Assesses the effects of the client’s use on his or her children (the prenatal effects, the effects on household safety, supervision, support systems, and any relationship to the children being physically abused, sexually abused, or neglected)

• Assesses the parent’s protective capacity

• Confirms the type of use (testing one of the following methods: instant swab, swab with confirmation, urine toxicology, or hair follicle test). For definitions, see 1922 Eligibility for Substance Abuse Testing.

1970 Drug-Endangered Children
1971 Drug Raids to Protect Drug-Endangered Children

In compliance with the Memorandum of Understanding between DFPS and the Texas Alliance for Drug Endangered Children, the CPS caseworker’s role is to:

• respond to law enforcement, when notified about a drug-endangered child;

• accept control of the child from law enforcement or first responders taking control of a child must be consistent within the context of CPS general removal policies;

• arrange for appropriate decontamination;

• arrange for immediate and follow-up medical care;

• conduct an initial interview with the child;

• make placement decisions; and

• collaborate on an ongoing basis with law enforcement, medical personnel, and a criminal prosecutor.

See Appendix 1971: Protocol for Working With Drug-Endangered Children for more information on caseworker procedures for dealing with drug-endangered children.

1972 Safety Tips for Visiting Homes or Areas Where Substance Abuse Is Practiced

Visits to homes where marijuana, other controlled substances, and alcohol are present can present additional safety risks to caseworkers. In addition to the general precautions caseworkers need to take in making home visits, the following are precautions specific to the presence of substance abuse in the home:

If …

then the caseworker …

a home is located in an area known for drug dealing …

before visiting the home:

• requests that a special investigator research, through law enforcement, the prevalence of criminal activity related to narcotics or violence that has taken place in the home; and

• requests that law enforcement officers assist when the caseworker goes to a home located in an area known for drug dealing.

one or both parents appear in the home to be intoxicated or incoherent …

• first ensures his or her own safety and the safety of the children;

• then calls law enforcement for assistance; and

• then calls the CPS supervisor for further guidance.

Considerations for Removal

A child is not removed simply because the parent is intoxicated. The caseworker weighs the following before deciding the action to take, when faced with an intoxicated parent:

• the child’s safety;

• the potential risk;

• the parent’s protective capacities; and

• CPS removal policies.

the caseworker suspects that he or she is in a home that is used as a drug factory, lab, or home where drugs are sold …

• calmly leaves the home; and

• calls law enforcement.

the caseworker observes drug use in the home …

does not take possession of the drug. CPS does not take possession of evidence. The caseworker calls law enforcement, if needed.

1973 Recognizing When a Caseworker Is Physically Exposed to Drugs

The caseworker needs to be familiar with some of the typical symptoms associated with drug exposure.

The symptoms the caseworker might experience if exposed to a drug substance are:

• shortness of breath;

• blue-colored skin;

• rapid breathing;

• anxiety;

• tightness in the chest;

• feeling fidgety; and

• pain when swallowing.

If the caseworker is exposed to a drug, he or she:

• seeks medical treatment, before taking any other steps; and then

• notifies his or her supervisor;

• completes, within one day of the incident, an Accident/Incident ReportExternal Link through the accessHR human resources system; and

• informs his or her physician about the suspected drug exposure.

Methamphetamine

If the caseworker suspects that he or she has been exposed to Methamphetamine, he or she contacts emergency medical personnel for decontamination and medical treatment.

1980 Assessing Substance Abuse
CPS June 2010

When assessing a client’s substance abuse, the caseworker does as follows:

• Assesses the nature of the client’s use (uses, abuses, is addicted, does not use)

• Assesses the effects of the client’s use on the client (physically, behaviorally, cognitively, socially, financially, and spiritually)

• Assesses the effects of the client’s use on his or her children (the prenatal effects, the effects on household safety, supervision, support systems, and any relationship to the children being physically abused, sexually abused, or neglected)

• Assesses the parent’s protective capacity

• Confirms the type of use (testing one of the following methods: instant swab, swab with confirmation, urine toxicology, or hair follicle test). For definitions, see 1922 Eligibility for Substance Abuse Testing.

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