New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington, West Virginia, and Wisconsin 5 Kansas, Nevada, New Hampshire, New Mexico, Vermont, and Virginia as affected by the mother's substance use as well as the treatment needs of the affected parent or caregiver.4 In six States, the plan can be initiated by the health-care provider at the birth hospital as part of the discharge process to ensure that the infant will receive appropriate care in the home.5 However, the responsibility for developing the plan ultimately rests with the State's child protective or child welfare agency. The POSC required by CAPTA may differ from a safety plan that addresses the immediate safety of the child. A POSC is determined by the State and can be continuous and a longer-term plan for the family that focuses on the infant's ongoing health, development, safety, and well-being. Developing the plan may include various professionals and disciplines. The agency may actively involve the parents or caregivers, the infant's healthcare professionals, the parents' or caregivers' substance use treatment service providers, out-of-home care providers, and supportive adults identified by the parents or caregivers. The plan also may include information from early childhood intervention providers, home visitors, public health personnel, and any other community supports, as appropriate. SERVICES FOR THE INFANT When the mother is in treatment during pregnancy, ideally the POSC is developed in advance of the infant’s birth so services can be in place and, when possible, placement of the infant in out-of-home care is prevented. If identification of the affected infant happens at the time of birth, the before the infant is discharged from the care of the health-care provider. The plan will address the safety, health, and substance use disorder treatment needs of the infant and affected family members or caregivers. Best practices indicate this should be done through the interdisciplinary coordination of services to enhance the overall well-being of the infant and his or her parents or caregivers. Services for the infant may include the following: Developmental screening and assessment Linkage to early intervention services Medical services needed to meet the ongoing health needs of the newborn Home visiting programs SERVICES FOR PARENTS OR OTHER CAREGIVERS Best practice tells us that a POSC should be designed to meet both the short- and longterm needs of the family, with the goal of strengthening the family and keeping the child safely in the home. A POSC includes several components, depending on the needs of the family, and may include the following: Substance use assessment and services Medical services needed to meet the ongoing health needs of the mother and other family members Mental health services Assistance with obtaining safe housing 6 Arizona, California, Delaware, Georgia, Kansas, Louisiana, Maryland, Nevada, North Dakota, Oklahoma, South Dakota, Virginia, and West Virginia 7 Delaware, Florida, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, and Vermont Instruction on the special care needs of the infant Provision of infant safe-sleep information and ensuring safe-sleep arrangements in the home Child care or respite care Vocational training for mothers seeking entry to the job market Comprehensive and coordinated social services, including family therapy groups, parent-child therapy, and residential support groups MONITORING PLANS OF SAFE CARE Laws and/or policies in 13 States require the child welfare department to monitor the implementation of a POSC to ensure that the specific action steps are completed.6 This includes ensuring the family or caregiver is receiving the treatment and appropriate services required by the plan and the infant is safe and receiving appropriate care. Confirming the services identified in the POSC are implemented will ensure the ongoing health and substance use treatment needs of the infant and family are met. The POSC is updated as needed as additional needs and referrals for services are identified. Laws or policies in 10 States require the child welfare department to collect data required to meet Federal and State reporting requirements.7 The data required, to the Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 6 extent practicable, to be submitted through the National Child Abuse and Neglect Data System,8 include the following: The number of infants identified as being affected by substance use, withdrawal symptoms, 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 Suggested Citation: Child Welfare Information Gateway. (2020). Plans of safe care for infants with prenatal substance exposure and their families. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. 8 The National Child Abuse and Neglect Data System (NCANDS) is a voluntary data collection system that gathers information from all 50 States, the District of Columbia, and Puerto Rico about