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Family and Children's
Resource Program

Vol. 24, No. 1
February 2019

Prevention via the Plan of Safe Care

Each year in the U.S., approximately 585,000 babies are born having been exposed to alcohol or drugs during pregnancy (Gardner, 2014). The impact on the infant varies based on the substance used, the extent and timing of the mother's use, and other factors (Behnke & Smith, 2013). While many of these children do well, some face life-long consequences. To improve outcomes for all children, we must focus on early identification and prevention of perinatal substance use.

A Period of Risk and Opportunity
The perinatal period presents unique risks for those who are substance dependent and their babies. However, it is also a time when there are unique opportunities for positive intervention (Goyer, et al., 2017). Indeed, as the following words from mothers illustrate, pregnancy can be a powerful motivator for recovery:

"I'm attached to him. I love him. I wanna fix my situation with my family. And yes, I'm always gonna have that desire [to use drugs], but I'm willing to fight it."

"I don't want my kids to ever have to go through the suffering that I have; the using, being homeless, being in jail, losing my kids or anything like that. I don't ever want them to feel any of that hurt."

Source: Cleveland, et al., 2016

If we are intentional in how we work with these families, we can decrease the long-term impact of prenatal substance use and prevent future child maltreatment.

A Plan of Safe Care
To this end, North Carolina develops a Plan of Safe Care (POSC) for these infants and families. In our state, medical providers must notify Child Protective Services (CPS) when they identify a substance affected infant. CPS Intake then develops a POSC and refers the family to Care Coordination for Children (CC4C) for ongoing services. The POSC typically calls for further and ongoing assessment and care planning to meet the needs and concerns of the child and family. While every plan is individualized, POSCs often include things such as referral for substance use treatment for the mother, meeting concrete needs (e.g., housing, food instability), and screening to determine if the child needs early intervention or other community-based services. If CPS accepts the report for an assessment, child welfare and CC4C work together to support the family. If a CPS assessment is not needed, CC4C implements the plan with the family.

POSCs focus on getting services and supports in place for the mother, child, and family as quickly as possible. Caring for a newborn can be challenging, so we want to do all we can to help make this transition safe and successful, while pushing the mother toward recovery.

How POSCs Aid Prevention Efforts

POSCs often involve voluntary services. Some notifications from medical providers do not meet the criteria for abuse and neglect and are screened out by CPS. For example:

  • An infant may experience withdrawal as a result of the mother's appropriate use of a prescribed medication during pregnancy.
  • A mother may test positive for a substance during the birth, but there is no demonstrated impact on the infant (e.g., the toxicology screen is negative, the child shows no sign of withdrawal), and the mother exhibits no behaviors that raise concerns about her capacity to parent the child.

By developing a POSC and referring these at-risk families to CC4C, CPS increases chances that services will be put in place to prevent future child welfare involvement.
Families are often more receptive to CC4C's voluntary services than to mandatory child welfare services. In fact, 82% of families with a POSC referred to CC4C agree to participate in services and care management.

Targeted parent education. CC4C provides parent education specific to families' needs. When substance use is an issue, CC4C staff teach parents to spot signs of withdrawal or developmental concerns in their child and when to seek medical attention or evaluation. Because rates of unintentional infant death are higher when parents or caregivers use substances, CC4C also educates parents and caregivers about safe sleep practices.

Ongoing connection with medical providers. Children exposed prenatally to substance use need ongoing follow up and preventative screenings by their medical provider to ensure they receive early detection and treatment for medical or developmental concerns. Families receiving CC4C services get preventative medical care at rates 10% higher than the average population (CC4C, personal communication, December 12, 2018).

Early identification and intervention is key in working with families and children affected by substance use. Giving these families access to affordable, effective services is a way to ensure the health, safety, and well-being of both the child and mother, while preventing further maltreatment (SAMSHA, 2016).

For more information and resources related to Plans of Safe Care, visit

Collaborating with CC4C
  1. Complete the DSS-1404 (CC4C Referral Form):
    • Include the child's name and any known contact information
    • Include the referral source as DSS
    • Check "CPS Plan of Safe Care"
    • Complete page 2
  2. Have a follow up conversation with the CC4C care manager to offer any further information that might help CC4C assess and engage the family.

References for this and other articles in this issue