Circle of Safe Care Plan

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 required 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.

In Rhode Island, a Plan of Safe Care is called a “Circle of Care Plan.” Circle of Care Plans are managed by the Perinatal Substance Use program at the Rhode Island Department of Health. Birthing hospitals are required to offer Circle of Care Plans to substance exposed newborns' adult caregivers. Circle of Care Plans document new and existing referrals that address the biopsychosocial needs of the infant and adult caregiver. Circle of Care Plans link 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 all providers understand and respond to the biopsychosocial complexities of a pregnant woman's situation to provide optimal perinatal and parenting support.

For more information about Circle of Care Plans, please visit the Rhode Island Department of Health’s website.