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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Policy and Practice Resources
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
Federal Guidance Program Instructions and Information Memoranda, 2016–2017
Administration for Children and Families
Visit Website Federal Guidance Program Instructions and Information Memoranda, 2016–2017
Program Instruction (PI) 1 (PDF 1.41 MB), April 13, 2016
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.”
Information Memorandum (IM) 1 (PDF 238 KB), August 26, 2016
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).
Program Instruction (PI) 2 (PDF 278 KB), January 17, 2017
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.
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.
Related Online Trainings, Videos, and Webinars
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.
- 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
Learning Academy 2018: Planning For Safe Care—What Your Family Drug Court Needs to Know
National Family Drug Court Training and Technical Assistance Program, 2018
The nation’s prescription drug and the opioid crisis have led to an increase in opioid use disorders among pregnant and parenting women. Best practices suggest the need for a collaborative response across systems to improve outcomes, reduce risks and adverse consequences for pregnant and parenting women and their infants, and help families remain together safely. This Learning Academy provides a variety of web-based learning elements including:
Visit Website Learning Academy 2018: Planning For Safe Care—What Your Family Drug Court Needs to Know
- A 30-minute pre-recorded webinar presentation addressing how Family Drug Courts and uniquely positioned to support Plans of Safe Care;
- A recording of a live webinar from July 2018 that features a facilitated discussion between a nationally recognized Family Drug Court judge and women’s healthcare and addiction medicine expert discussing best practices in collaboration important to meet the treatment and healthcare needs of both children and parents;
- Two podcasts that provide insights and in-depth exploration of medication-assisted treatment, family centered approaches to care, and Plans of Safe Care overviewed in the pre-recorded and live webinars. Both podcasts feature Jill Gresham, Senior Program Associate for Children and Family Futures, and Dr. Mishka Terplan, practicing addiction medicine physician and faculty member at Virginia Commonwealth University, School of Medicine; and
- Materials including a team discussion and call to action guide to support collaborative teams to examine their current practice and take important steps to improve approaches to planning for the safe care of infants and services to their parents/caregivers.
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
State and Local Examples
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
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
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
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
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?
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.
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