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, 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