Plan of Safe Care

In response to the nation’s prescription drug and opioid epidemic, Congress passed the Comprehensive Addiction and Recovery Act of 2016 (CARA). Section 503 of CARA aims to help states address the effects of substance use conditions on infants and families by amending the provisions of the Child Abuse Prevention and Treatment Act (CAPTA), first enacted in 1974, related to infants with prenatal substance exposure.

Specifically, CAPTA tasked states with developing policies and procedures that require health care providers to notify the child protective services system if they are involved in the delivery and care of an infant born and identified as being affected by prenatal substance exposure, including but not limited to withdrawal symptoms resulting from opioid exposure and Fetal Alcohol Spectrum Disorders related to prenatal alcohol exposure. CARA expanded “substance exposure” to include both illegal and legal substances.

CARA requires states to define what population of infants and families are identified as “substance affected,” what a Plan of Safe Care is, and who is responsible for developing and monitoring Plan of Safe Care.  The Rhode Island Department of Children, Youth & Families and the Rhode Island Department of Health worked together to draft the necessary responses to the federal requirements and established a process for ongoing monitoring.

Plan of Safe Care is managed by the Substance Exposed Newborns program at the Rhode Island Department of Health. Birthing hospitals are required to offer Plans of Safe Care to substance exposed newborns' adult caregivers. Plan of Safe Care has been integrated into the workflow of each hospital’s birthing unit since July 2018.

Plan of Safe Care documents new and existing referrals that address the bio-psycho-social needs of the infant and adult caregiver. It is not required to offer a Plan of Safe Care to infants with prenatal exposure to nicotine-only.  

Rhode Island’s implementation of Plan of Safe Care links substance exposed newborns and their adult caregivers to supportive services and resources. Pregnancy can be an opportunity for women and families to change behaviors around alcohol and substance use. It is important that all providers understand and respond to the biopsychosocial complexities of a pregnant woman's situation in order to provide optimal prenatal, postnatal, and parenting support.

For more information about Plan of Safe Care, please visit the Rhode Island Department of Health’s web page: here.