Plans of Safe Care

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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    • 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.

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1 Haight, S., et al. (2018). Opioid Use Disorder Documented at Delivery Hospitalization—United States, 1999–2014. Morbidity and Mortality Weekly Report, 67, 845–849.

2 Ko, J.Y., Patrick, S.W., Tong, V.T., Patel, R., Lind, J.N., & Barfield, W.D. (2016). Incidence of Neonatal Abstinence Syndrome – 28 States, 1999–2013. Morbidity and Mortality Weekly Report, 65, 799–802. DOI: