Plans of Safe Care

1. Plans of Safe Care Pennsylvania’s Support for Substance Exposed Infants and their Families

2. Agenda • What are Plans of Safe Care and why are they needed? • Who needs a Plan of Safe Care? • Who are the partners in supporting a Plan of Safe Care? • How are Plans of Safe Care developed and implemented? • Next Steps

3. What are Plans of Safe Care and why are they needed?

4. Define Plans of Safe Care • Ensure the safety and well-being of an infant who has been affected by substance use. • Include services and supports for both the infant and their mother and other caregivers. • Required in both federal and state legislation.

5. Define Plans of Safe Care

6. Define Plans of Safe Care

7. Define Plans of Safe Care

8. Impacts of Substance Exposure Prenatally Infants Physical, emotional, and/or developmental difficulties Ongoing challenges in stability and well-being • Associated with physical birth defects • Increased risk of regulatory difficulties • Increased risk of neuropsychological difficulties

9. Legislative Requirements Federal Legislation • Child Abuse Prevention and Treatment Act (CAPTA) • The Comprehensive Addiction and Recovery Act (CARA) of 2016  • Removes the term “illegal” in regard to substance abuse; • Requires that Plans of Safe Care address the needs of both the infant and the affected family or caregiver; • Specifies that data on affected infants and Plans of Safe Care be reported by states to the extent practicable. • Requires that states develop and implement monitoring systems regarding the implementation of Plans of Safe Care

10. Legislative Requirements State Legislation • Act 54 of 2018: Child Protective Services Law • Notification to the Department • Plan of Safe Care for Child up to One Year of Age • Development of Interagency Protocols

11. Effective Plans of Safe Care • Interdisciplinaryacross health and social service agencies • Comprehensivein their review of the physical, social-emotional, health, and safety needs of the infant and the parents or caregivers • Family-focusedas they assess and meet the needs of each family member, as well as overall family functioning and well-being • Timelyin their completion in the prenatal period or before the infant’s discharge from the hospital

12. Effective Plans of Safe Care • Easily accessible to relevant agencies with the appropriate confidentiality safeguards • Collaborativein identifying lead agencies for plan development, implementation, management, communication, and data submission • Evidence-informed, taking into account practices backed by research, such as a preference that infants, mothers and families remain together whenever possible

13. Think About . . . In your local area . . . . • Is there already a format or template for Plans of Safe Care?

14. Who Needs a Plan of Safe Care?

15. Who Needs a Plan of Safe Care? Newborns and Infants • Infants affected by substance use or withdrawal symptoms from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder

16. Who are the partners who can help support a Plan of Safe Care?

17. Partner Agencies

18. State and Local Partners Department of Drug & Alcohol Programs

19. State and Local Partners Department of Health

20. State and Local Partners Department of Human Services

21. State and Local Partners Other Pennsylvania Resources

22. Think About . . . In your local area . . . . • Are any agencies already partnering in the development & implementation of Plans of Safe Care?

23. How are Plans of Safe Care developed & implemented?

24. Steps to Developing Plan of Safe Care

25. Identify Mother and Infant Step 1: Universal Screening for Pregnant Women Alcohol and Other Drug Use Screening

26. Identify Mother and Infant Step 2: Universal Screening for Newborns

27. Steps to Developing Plan of Safe Care

28. Identify Mother and Infant Contact Childline 1-800-932-0313 http://www.compass.state.pa.us/cwis

29. Steps to Developing Plan of Safe Care

30. Multidisciplinary Teams (MDTS) Convening the team • For pregnant women: the healthcare provider or other appropriate staff person, such as a pain management specialist or patient care coordinator; • For infants identified as affected by substances at birth: the hospital social worker or other appropriate staff person, such as a patient care representative or discharge coordinator; • For infants identified as affected by substance use after their discharge from the hospital: a county children and youth caseworker.

31. Multidisciplinary Teams (MDTS) Determining the lead entity • Consider the following populations of women: • Women who are using legally prescribed medications, including opioids, for chronic pain or on medication that can result in withdrawal symptoms and do not have a substance use disorder; • Women who are receiving medication assisted treatment for an opioid use disorder and/or are actively engaged in treatment for a substance use disorder; • Women who are misusing prescription drugs or are using other legal or illegal substances, may meet criteria for a substance use disorder, and are not actively engaged in a treatment program.

32. Multidisciplinary Teams (MDTs)

33. State and Local Partners Peer Specialists Early Intervention Services Court System Managed Care Organizations and Private Insurers (e.g. Care Coordinators) Hospitals and Medical Providers (e.g. Hospital Social Workers) Public Health Maternal and Child Health Home Visitation Programs Substance Use Disorder Prevention and Treatment Providers Mental Health Providers Public and Private Children and Youth Agencies

34. Steps to Developing Plan of Safe Care

35. Developing Plans of Safe Care Identify Needs Initial needs identification may include: • Infant health and development • Child abuse and neglect risk and protective factors • Family members’ and caregivers’ need for substance use disorder treatment • Other health and social service supports in place or needed

36. Developing Plans of Safe Care Plan for Services • Which services could be considered for infants in order to enhance their short-term and long-term health, safety, and well-being outcomes? • What services could be considered for mothers, fathers, caregivers, and other family members?

37. Developing Plans of Safe Care An individualized approach • Engagement of the family system • Assessment of strengths, needs, and barriers • Coordination and collaboration of system • Resource identification and linkage • Monitoring

38. Think About . . . In your local area . . . . • Are there already multidisciplinary teams developing and implementing Plans of Safe Care?

39. Steps to Developing Plan of Safe Care

40. Monitoring Plans of Safe Care Statewide Monitoring of Plans of Safe Care Data Elements Include: • Number of infants identified as being affected • Number of infants for whom a Plan of Safe Care was developed; and • Number of infants for whom referrals were made

41. Next Steps For More Information • Refer to Pennsylvania’s Guidance Document for Plans of Safe Care – will be available on the KeepKidsSafe website once released • Contact: RA-PWPLANSOFSAFECARE@pa.gov

42. Next Steps Governor’s Institutes for Plans of Safe Care • March 4 & 5, 2019 – Kalahari • April 22 & 23, 2019 – Erie • May 23 & 24, 2019 – Pittsburgh • May 29 & 30, 2019 – Valley Forge • June 4-5, 2019 – Harrisburg

43. Thank you