{"report_id":350,"form_id":"22","user_id":81,"organization_id":13,"question_id":"322","question_type":"Free_Text","text_answer":"Learning Point: A CP intake was not screened within 24 hours. \r\nContributing to the CP intake not being screened within 24 hours was the type of allegation that was reported, neglect - prenatal exposure to controlled substance. The agency made a decision to hold off on screening the maltreatment report that was entered into SSIS by a backup staff. The back-up intake worker was balancing intake responsibilities with responsibilities of their primary workload, which resulted in tradeoffs. Additionally, the backup staff was not as familiar with intake procedures, as local agency practices for prenatal exposure reports had recently changed, which occurred following changes to DHS's maltreatment, screening, and response path guidelines. The changes to the guidance stemmed from DHS's interpretation of legislative changes around prenatal exposure and best practices were also defined by the state from Legislative statutes. Also influencing was a local agency workgroup, where their input and feedback on practical implementation strategies in response to prenatal exposure allegations was incorporated into the changes to guidance. The changes in guidance can conflict with the mandate to screen reports within 24 hours, as obtaining comprehensive information at the time of the report can take longer than 24 hours to receive.  \r\nThe agency interpretation of guidance influenced an internal practice change, where the agency held intakes open for prenatal exposure until they received more comprehensive collateral information from the medical provider. The agency's new practice prioritized making screening decisions based on lab verified toxicology results versus a positive result on an initial screening. Hospitals have policies and practices that vary in regard to testing for prenatal exposure and also for when they make a report for prenatal exposure allegations to child protection. The variability suggests some hospitals test all children, where others only test when certain criteria\/risks exist when the child is born. It is collectively known that some providers may test more mothers of marginalized groups using their mental models rooted from past experiences, creating an implicit bias. This bias subjects children of marginalized groups, and their mothers to increased toxicology testing, and potentially increases the number of reports made to child protection system when results are positive. It is also collectively known that other providers perceive there being a need to preserve the patient\/doctor relationship which also influences a confirmed positive toxicology report being made or not. This information on testing and reporting variability across hospitals influenced the agency's decision to wait for lab confirmed toxicology results before screening the report.  \r\nThis practice change was an adaptation from how the agency previously screened out prenatal exposure reports (prior to receipt of confirmed toxicology results) in order to meet the 24 hour timeline. Further Influencing the decision to not screen within 24 hours and wait for a confirmed toxicology result, was the agency's past experience of getting involved and working with families based on a positive initial screen, and later receiving information that the initial screen proved to be inaccurate and was a false positive. The agency worked to find balance between two priorities, the agency's role to protect children from harm and keep them safe, and the agency's duty to protect the privacy of children and families by not getting involved unjustly when credible evidence does not suggest alleged maltreatment. This goal conflict influenced the agency's decision to hold off on making a screening decision. \r\nThe local agency's interpretation of all the guidance changes supported their decision to seek collateral comprehensive information, which is suggested as best practice. Understanding it takes time, and the amount of time it takes to receive confirmed toxicology results from the lab is also dependent on, which type of toxicology test the medical provider chooses to order (urine sample, meconium, or blood cord tissue). For this case, a blood cord tissue sample was chosen, which provides most accurate results of toxicology, however, takes the most time for the lab to provide a report on the confirmed toxicology results. The time needed for child protection to wait for confirmed toxicology results contributed to the delay in screening. \r\nThe maltreatment, intake, screening, and response path guidance also require that agencies focus on vulnerability and risk of harm by assessing the impact chemical use or misuse has on child safety and use this as the primary consideration when screening. Understanding the mother's use alone did not constitute an unsafe child, the agency resolved the goal conflict by prioritizing the clause about \u00e2\u20ac\u02dcimpact of use or misuse on child safety', as the guidance suggests this be the primary consideration when screening. Furthermore, the agency considered risk associated with type of drug in which results are positive, for example, response to an allegation involving THC can be different than a response to an allegation involving methamphetamine. Since the child was presumed safe, consideration was given to the best interest of the child, and the agency sought to use a trauma informed approach that honored the newborn's innate biological needs for physical touch, bond, and attachment with the mother, prioritizing the presumption of safety over meeting the 24 hour screening compliance metric.","created_by":81,"updated_by":81,"updated_at":"5\/26\/2021 1:50:07 pm","created_at":"5\/26\/2021 1:50:07 pm","id":35214}