On Wednesday, November 13, 2019, the National Center on Substance Abuse and Child Welfare (NCSACW) hosted a facilitated discussion with representatives from child welfare and healthcare agencies from Colorado, Delaware, and New York. The webinar provided an overview of the treatment needs of pregnant women with substance use disorders and the effects of exposure to infants and treatment needs of infants with neonatal abstinence syndrome and infants in general. The webinar also highlighted the critical role collaboration plays to support parent treatment and recovery and infant safety and well-being and as well as elements of family-centered treatment and ways to ensure treatment is family-centered.

The speakers shared their experience and knowledge from their particular state in serving pregnant and parenting women with opioid and other substance use disorders through new requirements provided by the Child Abuse Prevention and Treatment Act (CAPTA) under the Comprehensive Addiction and Recovery Act (CARA). Specifically, CARA emphasizes that Plans of Safe Care address the needs of infants who are identified as affected by substance abuse, experience withdrawal symptoms, or have fetal alcohol spectrum disorders (FASD). Additionally, while states have latitude in stipulating what goes into their plan, a service plan for infants and their caregivers must be developed.

The recent opioid crisis saw a spike in pregnant women coming into hospitals with substance use disorders and babies being born with exposure to substances. Family-centered approaches allowed for agencies such as child welfare and departments of health to be more collaborative in their efforts to serve these families. States and localities have taken various approaches in addressing the needs of this population.

• In Colorado, the delivery bedside nurses of women whose infants present signs of substance exposure begin to work with mothers to develop a Plan of Safe Care.

• In Delaware, the state found that most mothers whose infants were born with exposure to the substance were already enrolled in a treatment plan, but should the mother consent, she and her baby would leave the hospital with a Plan of Safe Care as well.

• In New York, should an infant be born with substance exposure, and there are additional risks for abuse, the child welfare agency is tasked with developing the Plan of Safe Care. Should an expectant mother be seeking treatment for substance use before delivery, the providers develop the Plan of Safe Care, which she will take with her to the hospital when she delivers.

Overall, child welfare agencies are not the only ones charged with developing Plans of Safe Care—as previously mentioned; this is a collaborative effort. Contractors, substance use providers, nurses, and physicians can all be trained in developing a Plan of Safe Care for expectant or new mothers experiencing substance use. While these plans are ideal, participation is optional, and mothers have the right to decline a Plan of Safe Care. Instead of a Plan of Safe Care, safety assessments would still be conducted to ensure the health and safety of the infant before being discharged from a hospital into their mother’s care.