IEPS Notification

  • Infants Exposed Prenatally to Substances Notification

    For completion by health care providers and birthing facility staff only

  • Fill out this form only if an infant has been exposed to substances prenatally/in utero.

    If an infant was not exposed to substances in utero but there are other safety concerns, call your local child welfare intake number or 844-CO-4-KIDS to make a report of your concerns.

    For questions specific to Colorado’s Plan of Safe Care and/or the IEPS Notification Portal, email cdhs_IEPS@state.co.us.

  • Important: Please read before completing this form

    As a result of the federal Child Abuse Prevention and Treatment Act, the Colorado Department of Human Services (CDHS) is required to submit data to the United States Department of Health and Human Services regarding the frequency of infants being born affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure (42 U.S.C. §§ 5106(a)(7)(D)(v), (E); 5106a(d)(18). Additionally, CDHS must ensure there are policies and procedures in place to address the needs of infants born with and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including a process for health care providers involved in the delivery or care of such infants to notify the child protective services system of the occurrence of such condition of such infants (42 U.S.C. §§ 5106(b)(2)(B)(ii)).

    While the State must collect data for all infants identified as being prenatally exposed to substances, not all infants identified as being prenatally exposed are at risk for abuse and/or neglect require a report to child welfare (CRS 19-1-103(1)(a)(IV)). As such, Colorado has developed a separate pathway for completing a notification versus making a report for child safety concerns. Healthcare providers may now notify the Colorado child protective services system when they are involved in the delivery or care of infants affected by substance abuse or withdrawal symptoms by filling out this Infants Exposed Prenatally to Substances (IEPS) Notification form.

    Information is anonymous and strictly used for the required federal reporting and for quality improvement by the Colorado Department of Human Services. Information will not be shared or used for any other purpose.

    A notification is not the same as a report to child welfare. This notification form does not act as a report to Child Protective Services for potential abuse and/or neglect. If you have a concern about the safety or wellbeing of the infant, please call 844-CO-4-KIDS.

  • Reporter role*
  •  - -
  • Birth parent identifies their race/ethnicity as (select all that apply):*
  • Infant race/ethnicity (select all that apply):*
  • Type of substance(s) the infant was exposed to in utero (select all that apply)*
  • Were all prescribed substances taken as directed?*
  • How was infant exposure identified? (select all that apply)*
  • If the birth parent had a positive toxicology test, was consent obtained?
  • If the infant had a positive toxicology test, was parental consent obtained?
  • Has the infant been scheduled for follow-up care?*
  • Please select the type of follow-up care (select all that apply).
  • During the birth hospitalization/birth event, has the caregiver been offered resources or services to address parenting education, infant needs, physical health, behavioral health and/or substance use treatment needs?*
  • Which resources or services has the caregiver been offered? (Select all that apply)
  • Why have no resources or referrals been offered? (Select all that apply)
  • Has a Plan of Safe Care been developed?*
  • Why was no Plan of Safe Care developed?
  • Was the infant born with physical, developmental and/or behavioral impairments due to prenatal substance exposure?*
  • Is the infant experiencing withdrawal symptoms?*
  • Is there a care plan in place to manage withdrawal symptoms?
  • Have the parent(s)/caregiver(s) received education on how to meet the care taking needs of the infant?*
  • Has at least one safe and sober caregiver been identified to meet the care taking of the infant? (This can include the birth parent.)*

  • Please make a report to child welfare

    Because you indicated that no safe and sober caregiver has been identified, we ask that you make a report to child welfare so that a team of child welfare professionals can review and decide if the situation requires further assessment or involvement of the child welfare team. Call your local child welfare intake number or 844-CO-4-KIDS to make a report of your concerns for abuse and/or neglect. In addition to making a report to child welfare, we ask that you also complete and submit this form.

  • Do the parents/caregivers display an ability to fully meet the caretaking needs of the infant (i.e. medical care, feeding, soothing, diapering, safe sleep)?*

  • Please make a report to child welfare

    Because you indicated that the parents/caregivers do not display an ability to fully meet the caretaking needs of the infant, we ask that you make a report to child welfare so that a team of child welfare professionals can review and decide if the situation requires further assessment or involvement of the child welfare team. Call your local child welfare intake number or 844-CO-4-KIDS to make a report of your concerns for abuse and/or neglect. In addition to making a report to child welfare, we ask that you also complete and submit this form.

  • Is there evidence of ongoing substance use by the birthing parent that creates safety concerns for the infant?*

  • Please make a report to child welfare

    Because you indicated that there is evidence of ongoing substance use by the birthing parent that creates safety concerns for the infant, we ask that you make a report to child welfare so that a team of child welfare professionals can review and decide if the situation requires further assessment or involvement of the child welfare team. Call your local child welfare intake number or 844-CO-4-KIDS to make a report of your concerns for abuse and/or neglect. In addition to making a report to child welfare, we ask that you also complete and submit this form.

  • Are there other current safety concerns for the infant not related to the caregiver's substance use?*

  • Please make a report to child welfare

    Because you indicated that there other current safety concerns for the infant not related to the caregiver's substance use, we ask that you make a report to child welfare so that a team of child welfare professionals can review and decide if the situation requires further assessment or involvement of the child welfare team. Call your local child welfare intake number or 844-CO-4-KIDS to make a report of your concerns for abuse and/or neglect. In addition to making a report to child welfare, we ask that you also complete and submit this form.

  • Please click the Submit button to submit your responses.

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