ensure services are provided to the infant and the affected family or caregiver. There is also variation as to whether the plan is developed by a State's CPS agency or child welfare agency. While the plan may address the immediate safety, health, and developmental needs of the affected infant, the POSC also must include the health and substance use disorder treatment needs of the affected parents or caregivers. It is best practice that the POSC be developed with input from the parents and caregivers and in collaboration with the health-care provider and other professionals and agencies involved in serving the affected infant and family. It also includes referrals to appropriate services that support the affected infant and his or her family or caregivers. Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 3 NOTIFICATION/REPORTING REQUIREMENTS Laws and/or policies in approximately 42 States and the District of Columbia require health-care providers to notify CPS when they are involved in the delivery or care of infants who show evidence at birth of having been prenatally exposed to drugs, alcohol, or other controlled substances.2 Specifically, reports are required when the infant or mother has a toxicology screen that is positive for substances and/or the infant exhibits physical, neurological, or behavioral symptoms consistent with prenatal substance exposure, withdrawal symptoms from prenatal substance exposure, or FASD. While the notification to CPS is required by CAPTA, laws and/or policies in 14 States make clear that a notification is not considered a report of child abuse or neglect unless there is evidence of maltreatment or risk of harm to the infant.3 ASSESSMENT OF THE INFANT AND FAMILY Upon receiving a notification of an infant with prenatal substance exposure, the CPS agency makes an initial assessment to determine whether the infant meets the State's definition of child abuse or neglect. If the infant does not meet criteria for abuse or neglect, best practice is to refer the family to a community agency for assessment of the family’s needs. 2 The word "approximately" is used to stress the fact that States frequently amend their laws. This information is current through August 2019. Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, West Virginia, and Wisconsin require reports for substance-exposed infants. 3 California, Connecticut, Delaware, Georgia, Iowa, Louisiana, Maine, Michigan, New Mexico, New York, North Carolina, Pennsylvania, Vermont, and Virginia If the infant meets the State’s criteria for abuse or neglect, the infant and family will be referred to CPS for an investigation or family assessment. If the infant and family are screened in for services, a CPS agency conducts a safety assessment to determine whether the infant will be safe in the infant's home. The parents' ability to perform essential parental responsibilities may be considered in the assessment of the newborn's safety. Other factors that may be considered include the following: The mother's behavior and interaction/ bonding with the newborn Parental protective capacities of the mother and any other adult caregivers both in and out of the home The family's support system The home environment Evidence of preparation and safe care for the infant, such as a crib, clothing, and formula Mental health concerns or the presence of domestic violence Assessment of all other adults and children living in the home Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 4 Additional assessments are made to determine the ongoing needs of the infant and the infant's family and other caregivers for services and other supports. The assessments may include consideration of the following factors: The infant's current condition and/or special needs or disabilities The nature and extent of the mother's alcohol and drug use and treatment history Information on the parents' mental health concerns, such as postpartum depression and any co-occurring disorder The presence of other children in the home and their current care and condition Family strengths and involvement of the infant's father and other family members The mother's level of cooperation and willingness to address concerns The extent and availability of the newborn's family or other individuals to assist with caregiving and the provision of other support The availability of stable housing with no apparent safety or health hazards RESPONSIBILITY FOR DEVELOPMENT OF THE PLAN OF SAFE CARE Laws and policies in 33 States require the State agency to develop a POSC to address the health and substance use disorder treatment needs for any infant who has been identified 4 Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Maine, Maryland, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico,