Plans of Safe Care Infants With Prenatal Substance Exposure and Their Families - Vermont

Date: August 2019


Citation: Family Serv. Pol. Man., Pol. # 50

A 'plan of safe care' (POSC) is a written plan for a substance-exposed newborn and the infant's family that is focused on meeting health needs and substance disorder treatment needs and is developed in collaboration with the family, the health-care provider, community agencies, and child welfare, when appropriate.

Notification/Reporting Requirements

Citation: DCF POSC FAQs

Health-care providers involved in the care and delivery of substance-exposed newborns are responsible for making a notification to the Department for Children and Families (DCF). This ideally takes place prior to the newborn's discharge.

A report is made to DCF when there are child protection concerns by calling the child protection hotline. A notification is made to DCF when the newborn has been prenatally exposed to substances but there are no child protection concerns. A notification does not contain identifying information.

Regardless of whether or not there is an open case with DCF, hospital staff are mandated to make a report if there are child protection concerns, including substance exposure, as follows:

  • A newborn has a positive toxicology screen for illegal or nonprescribed substances, other than solely marijuana.
  • A newborn is being treated for neonatal abstinence syndrome as the result of maternal use of illegal, nonprescribed, or misuse of prescribed medication, or due to undetermined exposure.
  • A newborn has been diagnosed with fetal alcohol spectrum disorder.

Regardless of whether there is an open case with DCF, hospital staff are required to make a notification and complete a POSC if the substance exposure consists of the following:

  • The mother is stable and engaged in medication-assisted treatment with methadone or buprenorphine.
  • The mother is being treated with opioids for chronic pain by a physician.
  • The mother is taking benzodiazepines as prescribed by her physician.
  • The newborn was prenatally exposed to marijuana.

Assessment of the Infant and Family

This issue is not addressed in the statutes and regulations reviewed.

Responsibility for Development of the Plan of Safe Care

Citation: DCF POSC FAQs

When there are no child protection concerns related to the newborn, hospitals are required to complete the POSC with the mother/caregivers prior to discharge. If a report has been made to DCF because of child protection concerns, and the report is accepted, DCF will complete their own POSC.

The POSC should be provided to the newborn's primary care provider upon discharge. The primary care provider can use the information and engage the mother/caregiver at follow-up appointments. Hospital staff may choose to incorporate the POSC into their electronic records. The mother/caregivers should be given a copy of the POSC, and they are free to share that information with other providers and extended support network.

Services for the Infant

Citation: DCF POSC FAQs

Specific supports for the infant may include any of the following:

  • Home visiting
  • WIC
  • Children's integrated services
  • Child care
  • Safe sleep plan

Services for the Parents or Other Caregivers

Citation: DCF POSC FAQs

The plan provided to the mother will do the following:

  • Explain how to keep the baby healthy, including supports such as financial help, child care, and health-care services
  • Connect the mother to resources, including public benefits, support groups, well-baby visits, and information

Specific supports that may be discussed with the mother/caregiver in developing the POSC may include any of the following:

  • Medication-assisted treatment
  • Mental health counseling
  • Substance abuse counseling
  • Recovery supports
  • Smoking cessation
  • Parenting groups
  • Home visiting
  • WIC
  • Housing assistance
  • Financial assistance
  • Child care
  • Safe sleep plan

Monitoring Plans of Safe Care

Citation: DCF POSC FAQs

The purpose of the notification is to provide States and the Federal government with the number of substance-exposed infants on an annual basis to address the ongoing services and needs for this population. The annual numbers reported to the Federal government also include all accepted DCF child protection reports regarding substance-exposed newborns.