Date Issued: August 1, 2019
- All OASAS Certified Providers
- Local Governmental Units (LGU)
The purpose of this Local Services Bulletin (LSB) is to provide OASAS certified providers, who serve pregnant and parenting women, of changes to the Child Abuse Prevention and Treatment Act (CAPTA). Infants born substance exposed and/or who are identified as being affected by substance abuse or that have withdrawal symptoms resulting from prenatal substance exposure or Fetal Alcohol Spectrum Disorder (FASD) and their families or caregivers must have a Plan of Safe Care (POSC) developed.
BACKGROUND AND AUTHORITY
In 2003 the CAPTA i was amended to address the needs of infants born substance exposed and identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal substance exposure. The legislation required that governors of states receiving a CAPTA grant assure the federal government that they have policies and procedures for the following:
- Appropriate referrals to child protection service systems and for other appropriate services, to address the needs of infants born substance exposed and identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal substance exposure.
- A requirement that health care providers involved in the delivery or care of such infants notify the child protective services system of the occurrence of such condition except that such notification shall not be construed to establish a definition under federal law of what constitutes child abuse or require prosecution for any illegal action.
- POSC development for the infant born substance exposed and identified as being affected by illegal substance abuse or withdrawal symptoms.
- Immediate screening, risk and safety assessment, and prompt investigation of such reports.
The CAPTA Reauthorization Act of 2010ii made further changes related to prenatal exposure issues to include identification of infants affected by FASD and a requirement for the development of Plans of Safe Care for infants affected by FASD. It also added the following reporting requirements to the Annual Progress and Services Report:
- The number of children referred to a child protective services system born substance exposed and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal substance exposure or FASD.
The Comprehensive Addiction and Recovery Act (CARA)iii was signed into law on July 22, 2016, with the purpose of addressing the nation’s prescription drug and opioid epidemic. CARA went into effect July 22, 2016, including Title V, Section 503, “Infant Plan of Safe Care.” The legislation (PL 114-198) makes several changes to CAPTA, including:
- Removes the term “illegal” regarding substance abuse; substances of abuse may include prescribed medications as well as illegal substances and alcohol.
- Requires that Plans of Safe Care address the needs of both the infant and the affected family or caregiver.
- Specifies that data on affected infants and Plans of Safe Care be reported by states to the maximum extent practicable. Such data includes:
- The number of infants identified as being affected by substance abuse, withdrawal symptoms resulting from prenatal substance exposure, or FASD.
- The number of infants for whom a POSC was developed.
- The number of infants for whom referrals were made for appropriate services including services for the affected family or caregiver.
- Requires that states develop and implement monitoring systems regarding the implementation of such plans to determine whether and in what manner local entities are providing, in accordance with state requirements, referrals to and delivery of appropriate services for the infant and affected family or caregiver.
The development of a POSC is required to promote the safety and well-being of an infant born substance exposed and identified as affected by substance abuse or withdrawal symptoms resulting from prenatal substance exposure or FASD and their families or caregivers. The POSC should be developed as soon as the infant is identified as being affected by the mother’s prenatal substance use. Ideally, the POSC would be initiated during pregnancy and updated following delivery. Health care, addiction treatment providers and other service providers involved in caring for the women who use(d) substance(s) during pregnancy are required to help develop and implement the POSC for the mother and her newborn.
Providers may include obstetricians, gynecologists, nurse practitioners, midwives, OASAS certified providers, home visitors and early intervention programs. When more than one provider is involved in caring for the mother and child, they must work together to determine who is best suited to assume the lead for developing and monitoring the POSC.
OASAS certified providers who are working with a woman who is pregnant or becomes pregnant while in treatment will be required to ensure that she has a POSC, prior to the birth event.
A POSC should be a comprehensive multidisciplinary assessment, intervention and treatment plan that is coordinated across the multiple agencies involved in the mother-infant dyad. The parents/caregivers should be actively engaged in developing the plan. The POSC should address the parents and child’s physical, social-emotional health and safety needs, both prior to and after birth. The services provided should be family focused and tailored to meet the needs of each family member, thereby improving overall family functioning and wellbeing.
A POSC will vary depending upon the mother and child’s needs and circumstances but should address, at a minimum, the following:
- Basic needs, such has safe housing, medical care, mental health and substance use treatment needs, etc.
- Delivery and discharge plans that include prenatal and postnatal care, birthing location, creation of a safe sleep environment, family planning and plans for sharing information with other service providers. Support for mother and child during the first weeks after delivery should be a priority.
- Infant needs such as diapers and other basic care items, formula, breast feeding, pediatric care, early intervention services and referrals for other medical or developmental concerns.
- Supports for after delivery such as continuation of substance use treatment as needed, peer support, home visiting services and child welfare involvement, if needed.
Treatment providers working with pregnant women with a substance use disorder have both a unique opportunity and a responsibility to help prepare them for the birth of their infants and avoid a crisis. Such preparation must include education about CAPTA requirements, including hospital notifications to OCFS and the difference between a notification of an infant with prenatal exposure and a mandated report for an infant for whom there are concerns regarding the child’s health and safety. Additionally, treatment providers can help mothers-to-be understand and prepare for the potential effects of prenatal substance exposure such as Neonatal Abstinence Syndrome (NAS), including withdrawal and problems with feeding, sleeping and difficulty being consoled. Education and training prior to the birth event will help prepare mothers and their families to care for these infants upon discharge and to leave the hospital already connected to the supports and services they are likely to need.
Questions regarding the bulletin should be directed to [email protected].
SOURCE(S) OF FURTHER INFORMATION
If you require further clarification of the issues detailed in this Bulletin, please contact the Bureau of Adolescent, Women and Children’s Services or Local Regional Office.
/s/ Arlene González-Sánchez
i Child Abuse Prevention and Treatment Act (CAPTA), as amended by the Keeping Children and Families Safe Act of 2003
ii Child Abuse Prevention and Treatment Act (CAPTA) as amended by the CAPTA Reauthorization Act of 2010
iii Child Abuse Prevention and Treatment Act (CAPTA) as amended by P.L. 114-22 and P.L. 114-198, including the Justice for Victims of Trafficking Act of 2015 and the Comprehensive Addiction and Recovery Act of 2016