Plans 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 disorders on infants and families by amending provisions of the Child Abuse Prevention and Treatment Act (CAPTA), first enacted in 1974, that are 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 substance abuse or withdrawal symptoms resulting from prenatal substance exposure including those with Fetal Alcohol Spectrum Disorders. In recent legislation, 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 and Families and the Rhode Island Department of Health worked together to draft the necessary responses of the federal requirements and establish a process for ongoing monitoring. Plan of Safe Care is managed by the Rhode Island Department of Health Substance Exposed Newborns program. It is the responsibility of the birthing hospital to complete a Plan of Safe Care for each substance exposed newborn. 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 was decided that for infants with prenatal exposure to nicotine-only a Plan of Safe Care is not required. Rhode Island’s implementation of Plan of Safe Care is an effort to better link substance exposed newborns and their adult caregivers to services and resources. Pregnancy can be an opportunity for women and those close to them to change behaviors around alcohol and substance use. It is important for all providers to understand the complexity of a woman's social, environmental, mental and physical conditions in order to best provide support throughout pregnancy, in the postpartum period and throughout parenting. For more information about POSC, please visit the RI Department of Health’s Web page: here.