At the end of August, HHS issued an information memorandum (ACYF-CB-IM-16-0) to inform and assist states in implementing a “Plan of Safe Care” under the Child Abuse Prevention and Treatment Act (CAPTA) as amended by the recent Comprehensive Addiction and Recovery Act of 2016 the “CARA” legislation.

The drug treatment reform bill amended CAPTA in regard to a plan of safe care and directs HHS in a number of areas and requires states to address the health and substance use disorder and treatment needs of the infant and family caregiver, and directs a system of monitoring.

In the new Information Memorandum, HHS provides a description of the new requirements under CAPTA and describes some elements of a safe care plan including

  • Early identification, screening and engagement of pregnant women who are using substances.


  • Appropriate treatment for pregnant women, including timely access, comprehensive medication and guidelines and standards for treatment


  • Consistent hospital screening pregnant women, postpartum women and their infants


  • Consistent hospital notifications to CPS, including questions and responses that will help CPS hotline workers assess risk and protective factors and safety concerns


  • Memoranda of Agreement for information sharing and monitoring infants and families across systems


  • Ongoing care plans for mothers and their infants that include home visitation, early intervention services and recovery supports; and plans of safe care that are of sufficient duration

In addition, the memorandum provides some links to potential resources including “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.”  That document provides a case study of an effort in Burlington, Vermont that brings together a multidisciplinary group of agencies serving women with opioid use disorders.  Vermont has faced a major expansion in opioid addiction and use so much so that the Governor has highlighted the statewide problem in an earlier state of the state address.

Congress expanded previous requirements under CAPTA that attempts to address the substance use issue for infants exposed at birth.  The new provisions are more specific for states and more directive of HHS.   What Congress did not do is provide an increase in CAPTA state grants that are now under $26 million for all fifty states and the territories.