Plans of Safe Care
Over the last two decades, the nation has experienced a four-fold increase in opioid use disorders among pregnant women and three-fold increase in rates of neonatal abstinence syndrome among infants. 1, 2 Plans of Safe Care (POSC) for infants affected by illegal substance abuse have been a requirement in child welfare legislation since 2003, but, with these increases in opioid use disorder and neonatal abstinence syndrome, the focus on planning for the safe care of infants and support for their families has intensified.
In 2016, the Comprehensive Addiction and Recovery Act modified child welfare legislation to expand POSC to include all infants affected by substance abuse withdrawals symptoms or a fetal alcohol spectrum disorder and who require services be identified for the family/caregivers of these infants. The Administration for Children, Youth and Families, Children’s Bureau, which provides guidance related to POSC, has identified multi-system collaboration as a best practice to support affected infants and their families. The following resources support tribes, regions, states, and local jurisdictions as they consider how to collaborate in planning for the safe care of infants in their communities.
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Highlighted Resource
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 1 – Identification and Notification
(PDF 2 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 1 – Identification and Notification, 2021
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 2 – Plans of Safe Care Data and Monitoring
(PDF 3.1 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 2 – Plans of Safe Care Data and Monitoring, 2021
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 3 – Lessons from Implementation of Plans of Safe Care
(PDF 3 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 3 – Lessons from Implementation of Plans of Safe Care, 2021
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Policy and Practice Resources
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 1 – Identification and Notification
(PDF 2 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 1 – Identification and Notification, 2021
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 2 – Plans of Safe Care Data and Monitoring
(PDF 3.1 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 2 – Plans of Safe Care Data and Monitoring, 2021
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How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 3 – Lessons from Implementation of Plans of Safe Care
(PDF 3 MB)
National Center on Substance Abuse and Child Welfare, 2021
This series of briefs highlights states’ approaches to serving infants and their families affected by prenatal substance exposure. The briefs are derived from NCSACW’s review of states’ Annual Progress and Services Reports (APSRs) pertaining to Section 503 “Infant Plan of Safe Care” of the Child Abuse and Prevention Treatment Act (CAPTA) and years of practice-based experience providing technical assistance (TA) to support systems-level policy efforts and practice-level innovations to improve outcomes for these infants and families.
View Document How States Serve Infants and Their Families Affected by Prenatal Substance Exposure: Brief 3 – Lessons from Implementation of Plans of Safe Care, 2021
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Foster Care Entry Rates Grew Faster for Infants than for Children of Other Ages, 2011–2018
(PDF 2.9 MB)
Office of the Assistant Secretary for Planning and Evaluation (ASPE), 2021
This study summarizes national, state, and county-level increases in infant foster care entry. Between 2011 and 2018, increasing numbers of infants were removed from their parents or caregivers. Forty-four states had increases in infants entering foster care, with increases ranging from 2 percent to 124 percent; in 13 states, infant foster care entries rose more than 50 percent from 2011 to 2018.
View Document Foster Care Entry Rates Grew Faster for Infants than for Children of Other Ages, 2011–2018
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Plans of Safe Care: An Issue Brief for Judicial Officers
(PDF 409 KB)
National Quality Improvement Center for Collaborative Community Court Teams and National Center for State Courts (2020)
Judicial officers hear a variety of dependency matters from a unique vantage point. This often requires insight and education in areas beyond the law, such as substance use, mental health, and infant health and development. This briefing paper is intended to assist judicial officers presiding over collaborative community court teams to better understand Plans of Safe Care (POSC), the court’s role in implementing POSC, and the process of bringing together community partners to improve systems for infants with prenatal substance exposure and their families. It is also included as a resource on the Child Welfare Information Gateway.
View Document Plans of Safe Care: An Issue Brief for Judicial Officers
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Federal Guidance Program Instructions and Information Memoranda, 2016–2017
Administration for Children and Families
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Program Instruction (PI) 1
This PI details information to be included in the states’ Annual Progress and Services Report including the requirements in the Child Abuse and Prevention Treatment Act State Plan update. This PI specified that states must describe “which agency or entity is responsible for developing a Plan of Safe Care, how it is monitored, and how follow-up is conducted to ensure the safety of these infants.”
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Information Memorandum (IM) 1
This IM refers states to the resources of the National Center on Substance Abuse and Child Welfare (NCSACW) for developing practice that reflects coordinated, multi-system approaches. The memo provides information on key programmatic components that have shown promising results with this population and directs states to the NCSACW resource, A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical and Service Providers (PDF 1.53 MB).
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Program Instruction (PI) 2
This PI provides additional guidance on implementing provisions in the Comprehensive Addiction and Recovery Act specific to the removal of “illegal” drugs in regard to infants with prenatal exposure, the requirement that Plans of Safe Care address the needs of both infants and their families or caregivers, and the new requirements related to data collection and monitoring.
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Program Instruction (PI) 3 (PDF 1.21 MB), April 10, 2017
This PI provides guidance to states, territories, and insular areas on actions required to take to receive their allotments for federal fiscal year 2018. It summarizes the actions required in completion and submission of (1) the third APSR update to the 2015-2019 CFSP, (2) the Child Abuse and Prevention Treatment Act update, and (3), the CFS-101, Parts I, II, and III.
Visit Website Federal Guidance Program Instructions and Information Memoranda, 2016–2017
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Related Online Trainings, Videos, and Webinars
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Introduction to the Plan of Safe Care Learning Modules
This live webinar hosted by The National Center on Substance Abuse and Child Welfare (NCSACW) provides an overview of the Plan of Safe Care Learning Modules. The modules are designed to guide state, county, and local collaborative partners to improve systems and services for infants born with and identified as affected by substance abuse or withdrawal symptoms due to prenatal drug exposure or fetal alcohol spectrum disorder, and their affected family. This webinar also highlights considerations and practice examples that align with changes in the Child Abuse Prevention and Treatment Act (CAPTA) that support the health, safety, well-being, and recovery of these families through Plan of Safe Care development.
Presenter(s):
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- Ken DeCerchio, National Center on Substance Abuse and Child Welfare (NCSACW)
- Jill Gresham, National Center on Substance Abuse and Child Welfare (NCSACW)
Date: November 19, 2020
Watch Video Introduction to the Plan of Safe Care Learning Modules
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Model Examples for Plan of Safe Care Implementation: Live Panel Discussion
This live panel discussion hosted by The National Center on Substance Abuse and Child Welfare (NCSACW) features state and county child welfare professionals along with health care and substance use disorder representatives who discuss their work in developing and implementing Plans of Safe Care.
Presenter(s):
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- Jill Gresham, National Center on Substance Abuse and Child Welfare (NCSACW)
- Trenee Parker, Director, Division of Family Services within the Department of Services for Children, Youth and Their Families, Delaware
- Janet Cizek, President/CEO, Center for Therapeutic Interventions; Clinical Therapist, Child-Parent Psychotherapy (CPP) Rostered Clinician, Oklahoma
- Teresa Stephenson, Director of Medication; Stimulant Use, Women and Family Specific Treatment Services; State Opioid Treatment Authority, Oklahoma Department of Mental Health and Substance Abuse Services
- Monika Taylor, M.B.A., L.C.S.W., C.A.S.A.C., Director of Addiction Treatment Services, Crouse Health, New York
- Michelle Shepard, M.D., Pediatrician, University of Vermont Medical Center, Vermont
Date: December 8, 2020
Watch Video Model Examples for Plan of Safe Care Implementation: Live Panel Discussion
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Plans of Safe Care Learning Modules
National Center on Substance Abuse and Child Welfare, 2020
These modules are a five-part series on Plans of Safe Care (POSC) for infants born with and identified as affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, fetal alcohol spectrum disorder (FASD ), or their affected family or caregiver. The series is intended to guide state, tribal, and local collaborative partners in improving their systems and services for infants affected by prenatal substance exposure and their families. This series provides states and communities with considerations for implementing POSC to support the safety and well-being of families in their jurisdictions.
View Website Plans of Safe Care Learning Modules
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Connecticut’s Approach to Implementing Plans of Safe Care
This live webinar hosted by The National Center on Substance Abuse and Child Welfare (NCSACW) alongside representatives from Connecticut’s Mental Health & Addiction Services (DMHAS) and Department of Children and Families (DCF) discusses Connecticut’s on-line notification process and system related to CAPTA for infants affected by prenatal substance exposure and their families. This webinar provides an overview of treatment needs of pregnant women with substance use disorders, family-centered treatment, Connecticut’s approach to developing Plans of Safe Care (POSC), a review of their innovative on-line notification portal, its overall intent, and how the process differentiates from mandated reporting, and a discussion of their collaborative work and training with partner agencies involved in POSC development.
Presenter(s):
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- Linda Carpenter
National Center on Substance Abuse and Child Welfare (NCSACW)
- Mary Painter, LCSW, LADC
Director of the Office of Intimate Partner Violence and Substance Use Treatment and Recovery, Department of Children and Families (DCF)
- Shelly Nolan, MS, LPC
Director, Women’s Services, Office of the Commissioner Department of Mental Health & Addiction Services (DMHAS)
Date: November 19, 2019
Watch Video Connecticut’s Approach to Implementing Plans of Safe Care
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Supporting Your Collaborative When Planning for Safe Care for Infants with Prenatal Substance Exposure – Live Discussion Webinar
This live webinar hosted by the National Center on Substance Abuse and Child Welfare (NCSACW) alongside representatives from child welfare and healthcare from several states discusses shared experiences and knowledge for serving pregnant and parenting women with opioid and other substance use disorders. This webinar will provide an overview of treatment needs of pregnant women with substance use disorders, and the elements of family-centered treatment, the effects of exposure to infants and treatment needs of infants with neonatal abstinence syndrome and infants in general, the key role collaboration plays to support parent treatment and recovery and infant safety and well-being, Plans of Safe Care, and challenges experienced by partnerships in many different states.
Presenter(s):
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- Jean Blankenship
Child Welfare Program Specialist; Office on Child Abuse and Neglect, Children’s Bureau, ACYF, ACF, HHS
- Jill Gresham
Senior Associate; National Center on Substance Abuse and Child Welfare
- Trenee Parker
Director; Division of Family Services within the Department of Services for Children, Youth and Their Families; Delaware
- Jen Donahue
Child Abuse Investigation Coordinator; Office of the Child Advocate; Delaware
- Monika Taylor
Director Chemical Dependence; Crouse Health; New York
- Susan Morris
Substance Exposed Newborn Specialist; Child Protection Services Unit; Colorado
Date: November 13, 2019
Watch Video Supporting Your Collaborative When Planning for Safe Care for Infants with Prenatal Substance Exposure – Live Discussion Webinar
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Plans of Safe Care—What your Multidisciplinary Team Needs to Know
In 2016, Section 503 of the Comprehensive Addiction and Recovery Act (CARA) modified sections of the Child Abuse Prevention and Treatment Act (CAPTA) related to infants with prenatal substance exposure and Plans of Safe Care. The Administration for Children and Families (ACF) has provided related guidance in two Program Instructions (PI 17-02 and PI 17-05) and one Information Memorandum (IM 16-05). Key elements of the ACF related guidance include where states have flexibility; confirms that “the development of a plan of safe care is required whether or not the circumstances constitute child maltreatment under state law;” clarifies that CAPTA does not specifically define a ‘plan of safe care,’ encourages collaborative planning and implementation of services.
This webinar provides multidisciplinary teams with a shared understanding of the challenges facing infants and families affected by substance use disorders (SUD), identifies how diverse partners can contribute to a collaboration that supports the complex needs of these families and highlights resources that teams can use to support implementation of a collaborative approach to Plans of Safe Care for pregnant and parenting women with SUD, infants with prenatal substance exposure and their families.
Presenter(s):
Date: May 9, 2019
Watch Video Plans of Safe Care—What your Multidisciplinary Team Needs to Know
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Supporting Families in Child Welfare Affected by Opioid and Other Substance Use Disorders
National Center on Substance Abuse and Child Welfare, September 2017
Many systems are involved in decisions related to the treatment, care, and supervision of pregnant women with opioid use disorders. The systems are governed by a combination of federal regulations, state legislation, ethics, and system-specific guidelines. At times, this mix of regulations and guidelines can result in conflicting recommendations regarding medical care, substance use treatment, and child safety. Professionals in these systems must establish mechanisms for working together to develop a family-centered and coordinated approach. This webinar focuses on strategies to overcome these challenges by strengthening collaboration to support Plans of Safe Care.
Watch Video Supporting Families in Child Welfare Affected by Opioid and Other Substance Use Disorders
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State and Local Examples
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On the Ground: How States Are Addressing Plans of Safe Care for Infants with Prenatal Substance Exposure and Their Families
(PDF 631 KB)
National Center on Substance Abuse and Child Welfare, 2019
This technical assistance tool provides on-the-ground examples from states across the country that have implemented comprehensive approaches to Plans of Safe Care (POSC) for Infants with Prenatal Substance Exposure (IPSE) and their families and caregivers. These concrete examples can help states and agencies consider practice and policy systems changes to best serve these families in their own communities.
View Document On the Ground: How States Are Addressing Plans of Safe Care for Infants with Prenatal Substance Exposure and Their Families
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North Carolina: Infant Plan of Safe Care
North Carolina Department of Health and Human Services, 2018
This web-based resource provides education and information about Plans of Safe Care in North Carolina including sample forms, definitions, and links to collaborative partners involved in Plans of Safe Care.
Visit Website North Carolina: Infant Plan of Safe Care
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Perinatal Substance Use: Promoting Healthy Outcomes—Virginia Legal Requirements and Health Care Practice Implications—A Guide for Hospital and Health Care Providers
(PDF 441 KB)
Virginia Department of Social Services, 2017
This brochure describes Virginia’s legal requirements and the implications for practice in promoting healthy maternal and infant outcomes. The Code of Virginia sets forth screening and reporting requirements for healthcare providers and hospitals, and this brochure highlights information and responsibilities related to Plans of Safe Care in Virginia.
View Document Perinatal Substance Use: Promoting Healthy Outcomes—Virginia Legal Requirements and Health Care Practice Implications—A Guide for Hospital and Health Care Providers
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Additional Resources
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Child Abuse and Prevention Treatment Act (CAPTA), Prenatal Substance Exposure Statutory Summary
(PDF 527 KB)
National Center on Substance Abuse and Child Welfare, 2017
This document summarizes the history of the CAPTA prenatal exposure provisions, including the July 2016 Comprehensive Addiction and Recovery Act changes to the legislation.
View Document Child Abuse and Prevention Treatment Act (CAPTA), Prenatal Substance Exposure Statutory Summary
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Safe Children Information Packet: What are Infant Plans of Safe Care and Some Examples of State Responses to Infants Affected by Substance Abuse?
(PDF 1.0 MB)
Casey Family Programs, 2017
This information packet provides legislative and policy context for developing Plans of Safe Care for infants affected by prenatal substance exposure and their parents and families. It provides an overview of key legislation, implementation considerations, and jurisdictional examples.
View Document Safe Children Information Packet: What are Infant Plans of Safe Care and Some Examples of State Responses to Infants Affected by Substance Abuse?
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A Planning Guide: Steps to Support a Comprehensive Approach to Plans of Safe Care
(PDF 821 KB)
National Center on Substance Abuse and Child Welfare, 2018
This technical assistance tool suggests 10 steps a community may consider when developing a comprehensive approach to implementing Plans of Safe Care.
View Document A Planning Guide: Steps to Support a Comprehensive Approach to Plans of Safe Care.
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Summary 2017 Policy Academy: Improving Outcomes for Pregnant Women and Postpartum Women with Opioid Use Disorders and Their Infants, Families and Caregivers
(PDF 866 KB)
Substance Abuse and Mental Health Services Administration and the Children’s Bureau, 2017
This summary briefly reviews the scope of the challenges, the current policy and practice environment, and the information presented and discussed at the 2017 Policy Academy, convened in Baltimore, Maryland, in February 2017. Child welfare, substance use treatment, court, and healthcare partners from 15 state teams participated in this two-day academy. This summary previews the work undertaken by the state teams as they begin their action planning related to implementation of the 2016 Comprehensive Addiction and Recovery Act amendments to the Child Abuse and Prevention Treatment Act and the development of collaborative approaches to Plans of Safe Care.
View Document Summary 2017 Policy Academy: Improving Outcomes for Pregnant Women and Postpartum Women with Opioid Use Disorders and Their Infants, Families and Caregivers
