Child Protection- What WE do

1. Child Protection- What WE do Including : 1. SAFE CARE PLANS for Infants(CAPTA Requirement) 2. Neonatal Abstinence Syndrome 3. Drug Screening Revised March 9, 2016

2. BIA/Tribal Worker’s Responsibilities: When you receive a referral: 1. Determine if the referral involves individuals that are eligible for service(enrolled, living on reservation and a protection concern), or do they need to be referred elsewhere 2. Is it a Child Protection referral or a Child and Family Service referral. This is done by gathering information to clarify the situation being reported and helps determine the response(Differential Response- DR). If the family is eligible for services: • Is this a new or current incident • Do you have adequate information to act on the referral, if not what other information do you need • Is there imminent danger that must be dealt with immediately which may require an out of home placement or can you engage the family in a helping process and work with them over a period of time

3. Feb. 3, 2016 • It is Indian Affairs policy to protect at risk children and families • Waiver is in the best interest of Indians • Allows BIA and Tribal staff to provide child protection and child assistance services when placement is necessary for any child less than one year who is eligible for enrollment and whose parents are tribal members, and the child is drug affected or in need of protection • Waiver allows for protection until child is officially enrolled in Tribe Approval of Blanket Waiver of Enrollment Requirement for Child Assistance Payments for Children Less Than One Year of Age Who are Drug Affected or In Need of Protection

4. Worker’s Responsibility cont. • Respond to referrals in a timely manner(within 36 hours to identify imminent danger) • Provide accurate, factual information, findings or recommendations to supervisor and other workers when staffing • Document findings in the file- written or computerized file • Treat customers/clients with respect • Follow regulations and policy to assure that clients receive the services they deserve • This is a team effort- respect coworkers and other programs and staff

5. Worker Job Responsibilities: • Know what you were hired to do(position description) • Discuss with your supervisor expectations for your position • Seek out information to know how to meet the job requirements- these include • Personnel policies • Laws, Code • Regulations, procedures, policies • Learn the resources in your community you will need to work with • If the court will be involved- learn their procedures and requirements • Document your activity and review with supervisor/coworkers as appropriate • Comply with financial requirements if payment must be made to customer – enter information in system

6. Supervisor Responsibilities: • Know the programs which you are supervising and program requirements 25 CFR Parts 20,23,63 and 115 and policy directives. Comply with supervisory review requirements in 25 CFR Part 20 • Assign cases and try to ensure equitable caseloads for each worker. Meet with worker’s individually to discuss their cases. • Staff cases as a team, especially difficult or problematic cases- be supportive to staff. Develop a sense of teamwork in the program • Complete administrative duties assigned- FASSR, ICWA quarterly reports(including CAN reports etc.) • Carry a caseload if supervising less than 5 staff

7. What is Needed on a Referral: To determine what type of referral you have and you rresponse- you need to get sufficient information when you take the referral: • Who was involved-names dates of birth or ages of children involved and where do they live, and names and addresses of the adults involved • What happened • When did it happen • Where did it happen- get as specific information as possible • Who is the person making the referral, or who else or what other agency/program may have information about the situation • Has this situation or a similar situation been referred previously • Are there any special issues to consider e.g. special needs of the child, one parent is non-Indian, jurisdiction etc.

8. Understanding A Referral: Listen & Question • Listen to the referent- make sure you understand the referral/the problem • Obtain back up information needed to address referral- that includes assessing any safety concerns when going to the home • Staff case with supervisor and other staff to make determination if CP or CFS/DR • Revisit after initial assessment • A Centralized Intake referral is just another referral- an assessment must be completed before any action is taken

9. The Response: Two Paths-Child Protection or Child & Family Services-Differential Response CP requires initial investigation in 36 hours Cross referral to Law Enforcement Assessment/investigation is necessary to determine path or need for placement Indian Child Protection and Family Violence Prevention Act PL 101-630 Requirements

10. Initial assessment (investigation): Completed within 36 hours • The primary purpose is to determine if there is imminent danger to the child(ren), does the child need to be removed? • Factual information must be gathered, which may include physical evidence, a review of any history with the family, interviews of relevant individuals and information from other resources. If law enforcement was called, include the police report, if available. • Review the referral, and once the need for the child’s protection (imminent danger) is clarified, the initial response is chosen CP or DR- based on the findings of the initial assessment/investigation

11. What is ‘a Child in Need of Protection’: • The only basis for a placement with BIA funds • May be due to physical, sexual abuse or neglect by others • May be due to the environment: a living situation which endangers child due to access or use of alcohol or drugs by child or adults, and may result in deviant behavior • Abandonment and/or homelessness with no supervision • Physical or mental condition that may injure child and no adult able or willing to care for them • Must be able to demonstrate/prove “need for protection” in your assessment/report to the court if care and supervision is sought for placement

12. Initial Assessment/Investigation: • An initial investigation must be completed within 36 hours and determine if it is Child Protection(CP) and there is Imminent danger. If CP cross refer to Law Enforcement. • If Child and Family Service(CFS) develop a Differential Response case plan • Initial investigation may be a telephone contact or contact with another agency to clarify concerns- depending on content of referral and child protection concerns • Assess/investigate the situation- contact child(ren) and adults involved in the referral • Talk to children alone first whenever possible, and then the parents or adults. • Other resources may provide substantive information, e.g. IHS, the school etc.

13. The Differences Between CP & CFS/DR Child Protection (CP) Child& Family Services (CFS) or Differential Response (DR) Child protection concerns, but safety concern is not an imminent danger-been ongoing Family members willing to protect, there is a viable support system Parents/guardian agree to work on a case plan • Child in need of protection • Imminent danger identified • No one to protect the child • Family will not voluntarily work with program • Violent /sexual offenders have access to children

14. Communicate/ Engage With Clients:"Interview" • Ask questions- clarify the facts involved. This is a social services interview, not a forensic interview. • You are not law enforcement- we are not just looking at the parents drug or alcohol use or possible criminal activity • Assess the support system, including other family members and the child’s safety • Develop a narrative on the case Children, Parents, Other Adults, Youth and Resources

15. Revisit Assessment & Staff With Supervisor • Revisit the initial information • Discuss with the client their concerns-what do they think needs to be done • Develop action steps with the child and family members involved • Establish timeframes for actions • Make them reasonable, not overwhelming or unachievable, incremental • Monitor, review and document progress • Build on successes- baby steps • Be honest with your clients- discuss what is needed to achieve their goal Establish a Case Plan:

16. Case Planning: Involves Identifying Concerns, Available Resources and Outcomes • Identify the problem or issue the client must address- their perspective and yours. These may not be the same, but you need to work with the client on their needs from their perspective • What resources are available to address the problem: within the family, other resources, and outside the community • Client and worker should sign the plan and agree on how to monitor progress and at certain timeframes-usually every 3- 6 months. This can be shorter if client and worker agree, e.g. monthly. • Follow up is necessary to monitor progress or lack of it and redefine goals if necessary • Outcomes should be identified to determine if progress is achieved or not.

17. Timelines to Follow: • Within 36 hours : Initial contact & initial assessment • Locate placement resources and make placement if there is a need for protection(backgrounds and home study needed on relative placements for all adults in home- Purpose Code X is a resource) • Generally within 72 hours if placement is needed- comply with Tribal code requirements for submitting report to the court (do this as soon as possible to ensure notice is provided to the family) • If court orders placement or investigative authority- complete assessment on child and family, and provide report to the court as required prior to hearing • If court procedures are not followed, case could get dismissed, and the child returned to a dangerous situation • Develop a case plan with the client within 30 days • Know your next court date- 30 days, six months etc. based on Tribal code, and submit report prior to hearing

18. Purpose Code X • Criminal Background Checks- Exigent Circumstances Effective May 13, 2015, the Bureau of Indian Affairs, Office of Justice Services (OJS), on behalf of federally-recognized tribes, is authorized under the Fingerprint Submission Requirements Rule (Title 28, Code of Federal Regulations, Sections 901.2 and 901.3) to access the Interstate Identification Index (III) System on a delayed fingerprint submission basis when conducting criminal history record checks of residents with whom children are to be temporarily placed during exigent circumstances. Federally-recognized tribes that receive funds under the Indian Self-Determination and Education Assistance Act ((Title 25, United States Code (U.S.C.), § 450, et. seq) or the Tribally Controlled Schools Act (25 U.S.C. § 2501, et. seq) are authorized to access criminal history record information (CHRI) pursuant to Public Law (Pub. L.) 101-630 (25 U.S.C., §§ 3205 and 3207).

19. Sample BIA Case File Information: The Case File may include the following sections: • Identifying information- Application for Assistance, Enrollment, CDIB, Birth certificate, Social Security Card, Medicaid card, documentation that the child/family lives on or in a designated service area, picture of child or client. • The assessment- this includes case information compiled to determine if the child is in need of protection or this is a child and family service case and the family needs services( and is willing to engage with the worker) to protect the child . This section should also contain the case plan, updated narratives and documentation of monthly home visits. • Court orders and reports to the court- most current on top. Orders need to be provided timely, and contain required eligibility language, e.g. IV-E language. Make sure you get a court order within 5 workdays or follow up with the tribal court. • Placement information- if the child is placed with relatives or in foster care need placement agreement which identifies roles and responsibilities and payment if there is one, current license for foster home, and list of previous placements. Relative placements should include a home study and verification of acceptable backgrounds of all adults over 18 in the home. Picture of child if possible. • Payment section- invoice or information for billing, and documentation of payment

20. Coordination of Resources & Programs: • The BIA program is the resource of last resort- which means all other resources including Title IV-E, SSI, other federal or state programs should be used first, • BIA regulations were revised to mirror Title IV-E requirements- to make it easier for IV-E eligibility • If placement is not necessary and the family can be provided services(DR)- the Meth Initiative Prevention program can also be used as a resource, if basic eligibility is met • Meth Prevention Initiative and PL 93-638 contract staff should be able to provide a continuum of services, based on the family assessment and case plan • Whenever a child needs placement the Tribal Code and Tribal court requirements must be followed. When presenting a case in court- reports must be provided timely and staff should be prepared to testify to the facts of the case(without referring to the case file). • Tribal staff may be funded by both IV-E and BIA , with the understanding that IV-E may require a time study to identify what portion of time is being spent on IV-E activity

21. Child Protection Data: Trends 2012-2016 • Child protection reporting has improved resulting in increase referrals each year • Child neglect continues to be the largest category of child protection referrals • Sexual abuse numbers remain proportionally the same over years, but physical abuse has shown an increase • Child protection placements appear to be increasing • Drug related issues have replaced alcohol as a primary reason for protection • More infants with specialized needs are being referred for assessment and placement • It has become increasingly difficult to fill child protection positions and find foster homes- resulting in higher caseloads and stress for staff

22. Source: Fiscal Year 2012 to 2015 – BIA Agencies and Tribal Programs monthly child abuse and neglect data reports. Note: Data is not provide for Blackfeet July to December 2012, July to September 2013; Fort Belknap August to September 2013; Eastern Shoshone June to September 2013; Northern Arapaho June to September 2013; Chippewa Cree February to September 2013; Blackfeet November to December 2013, February to March 2014, May to June 2014, August to September 2014; Fort Belknap September 2014; Fort Peck September 2014; Eastern Shoshone March to September 2014; Northern Cheyenne Agency June 2015, and Crow Agency July to August.

23. Source: Fiscal Year 2012 to 2015 – BIA Agencies and Tribal Programs monthly child abuse and neglect data reports. Note: Data is not provide for Blackfeet July to December 2012, July to September 2013; Fort Belknap August to September 2013; Eastern Shoshone June to September 2013; Northern Arapaho June to September 2013; Chippewa Cree February to September 2013; Blackfeet November to December 2013, February to March 2014, May to June 2014, August to September 2014; Fort Belknap September 2014; Fort Peck September 2014; Eastern Shoshone March to September 2014; Northern Cheyenne Agency June 2015, and Crow Agency July to August.

24. Child Abuse Prevention and Treatment Act (CAPTA) Amendments 2010 • Requires state law or statewide program that includes: policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born with and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including a requirement that health care providers involved in the delivery of care of such infants notify the child protective services system of the occurrence of such condition in such infants, except that such notification shall not be construed to:1. establish a definition under Federal law of what constitutes child abuse or neglect; or 2. require prosecution for any illegal action. • III. the development of a plan of safe care for the infant born and identified as being affected by illegal substance abuse or withdrawal symptoms or a Fetal Alcohol Spectrum Disorder • This law requires a referral to child protection/social services for an assessment of the needs of the child and the family. It does not mean an automatic child placement.

25. Plan of Safe Care: CAPTA Requirement • Statute does not specify which agency or entity must develop plan of safe care • The plan should of safe care should address the needs of the child as well as those of the parent(s) as appropriate • Plan should assure that appropriate services are provided to ensure the infant’s safety • CAPTA requires the State to have triage procedures, including the use of differential response for the appropriate referral of a child not at risk of imminent harm to a community organization or voluntary protective service • The statute does not prescribe a point in time in which a referral to a community organization must be made. There is flexibility to determine appropriate procedures for when and how to refer a child it determines is not at imminent risk .

26. Protocol for Infants Referred by Billings Hospitals When a hospital calls or a Centralized Intake referral is received, if you want the Regional BIA Office to assist: • Provide a copy of the Intake to the Indian Services Officer/Regional Social Worker, and request an initial assessment(406)247-7989. • If RMR social services indicates they can complete the assessment, notify the hospital that RMR social service staff will be doing the assessment. • Schedule a conference call to discuss findings and recommendations within 48 hours • RMR social service will indicate when the written assessment will be completed. An initial case plan should be discussed and completed, if possible with the parent or family at the hospital(utilizing Differential Response). • If parents/family are uncooperative and the child needs protection, inform the referring agency, coordinate information for a report to the court and possible resources for placement • Work with the RMR to facilitate the placement if needed Social Service contacts for the two hospitals in Billings: Kathy Fox St. Vincent Health Care 1233 North 30th St. Billings, Mt. 59101 406-23707000 Supervisor- Doug Anderson 406-247-3360 Cathy Watts Billings Clinic 801 N. 29th St. Billings, Mt. 59101 (406)247-6344

27. Signs and Symptoms of Neonatal Abstinence Syndrome • Time it takes for baby to start showing symptoms of withdrawal will be variable • Depends on dose baby exposed to, mixing of drugs and the amount of time it takes for the drug to exit body • Some drugs remain in body longer which delays signs of withdrawal • Period of time baby will need monitoring dependent on type of exposure: • Minimum of 2 days for: cocaine, short acting narcotics(Morphine, Oxycodone, Percocet) • Minimum of 4 days for: barbiturates (Fioricet, Amytal, etc.), Heroin, and long acting opioids (Methadone, Subutex, Subuxone) High Pitched Cry/Excessive Fussiness Shaking/ jittery Trouble sleeping between feedings Stuffy nose/repeated sneezing Frequent yawning Difficulty feeding due to poor sucking ability Stiff muscle tone- especially in arms & legs Vomiting/diarrhea Poor weight gain after the 4th day of life Fast Breathing Skin breakdown/irritation particularly on face and diaper area Seizures

28. New Issues to Consider: • Drug testing by staff: Make sure staff have been trained in proper testing procedures if findings are going to be used in court. • State probation had offered to train staff and provide supplies for Fort Belknap, Chippewa Cree and Blackfeet Contact: Mike Barthel, Supervisor Havre State Probation & Parole, other Tribes would have to identify local contact • Would like Social Service/Meth projects to report on number of drug affected babies in quarterly reports • RMR will assist with cases in Billings if requested, but referral information must be provided the Regional Social Worker including court orders. They will assign the case to a worker.

29. Impact /Opportunities Resulting from CAPTA: • More referrals from hospitals due to Neonatal Abstinence Syndrome-withdrawal symptoms that a baby experiences after birth when they are no longer being exposed to certain drugs or medications • The need for a training program for caregivers and staff to understand the problem and care for the special needs of these children(drug or alcohol affected) • A need to coordinate with other programs serving these babies and their parents for treatment, referral and support services • The need for a protocol/process to assess the needs of the child and family and develop a safe care plan • Increased referrals of infants require more foster homes and specialized resources for infants affected by drugs or alcohol. • A multi-disciplinary team approach was recommended during the passage of the law.