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

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

In policy: 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: CAPTA FAQs

In policy: Regardless of whether there is an open case with the Department for Children and Families (DCF), hospital staff are required to do the following:

• Make a report if there are any child safety concerns
• Make a report for any of the following situations:
  • A newborn has a positive confirmed toxicology result (urine, meconium, or cord) for an illegal substance or nonprescribed medication.
  • A newborn develops signs or symptoms of withdrawal (neonatal abstinence syndrome) as the result of exposure to illegal substances, use of nonprescribed medications, misuse of prescribed medication, or due to undetermined exposure.
  • A newborn is suspected of having fetal alcohol spectrum disorder, or the pregnant individual had active alcohol use disorder during the last trimester of pregnancy.
• Make a notification if there are no child safety concerns and the substance exposure consists of either of the following:
  • Medications for addiction treatment (MAT), opioids for chronic pain, or benzodiazepines prescribed by a health-care provider
  • Prescribed or recreational marijuana (after the first trimester)

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

In policy: In Vermont, a POSC is required for infants when either of the following applies to the pregnant individual: 

• They were treated by a health-care provider with MAT, prescribed opioids for chronic pain, or prescribed benzodiazepines.
• They used prescribed or recreational marijuana after the first trimester.

The POSC should be developed with the pregnant individual and other involved caregivers. Ideally, the POSC should be started prenatally at the obstetric or midwifery office or by MAT providers. The POSC would then be shared with the birth hospital staff for completion after the infant is born. Each birth hospital should identify a workflow for POSC completion. This includes identifying care managers, social workers, or nursing staff who will work with families to review and complete the POSC.

Note: If a DCF report has been made and an assessment is opened, DCF will complete the POSC.

The completed POSC should be sent to the newborn's primary care provider at hospital discharge to facilitate communication and follow-up of new referrals. The goal is to involve families in the POSC process; however, they may decline. In these instances, hospital staff should complete the POSC with available information and share it with the infant's primary care provider at discharge. The refusal to develop a POSC does not warrant a DCF child protection report if no child safety concerns are present.

Services for the Infant
Citation: DCF POSC FAQs

In Vermont, the goal of the POSC is to ensure that substance-exposed infants and their families are connected to appropriate resources and services in their communities.

Services for the Parents or Other Caregivers
Citation: Ann. Stat. Tit. 18, § 4774(b)(6); DCF POSC FAQs

Expenditures from the Opioid Abatement Special Fund shall be used for addressing the needs of pregnant or parenting individuals and their families, including babies with neonatal abstinence syndrome.

In policy: In Vermont, the goal of the POSC is to ensure that substance-exposed infants and their families are connected to appropriate resources and services in their communities.

Monitoring Plans of Safe Care
Citation: CAPTA FAQs

Under the Federal Child Abuse Prevention and Treatment Act (CAPTA), each State must provide the Children's Bureau with certain data regarding substance-exposed newborns. In Vermont the de-identified CAPTA notification form was developed to allow DCF to compile de-identified data for this annual reporting.

Birth hospital staff complete CAPTA notifications. Each birth hospital should develop a protocol and workflow for completing and sending CAPTA notification forms to DCF in a timely fashion. Notifications must be made after the infant is born and submitted at hospital discharge.