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Collaborative Care: Implementing Plans Of Safe Care

Understand Federal and State laws on maternal substance use, develop Plan of Safe Care (POSC) for families, infants with substance exposure, history of CAPTA, importance of POSC in home visiting services, signs to look for, engaging families, and updating POSC regularly.

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Collaborative Care: Implementing Plans Of Safe Care

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  1. “PUTTING THE PIECES TOGETHER”COLLABORATIVE CARE: “Implementing Plans Of Safe Care” Dierdre H. Pearson, LCSW, CSAC Director, Women’s SUD & Co-Occurring Services Richmond Behavioral Health Authority

  2. To understand Federal and State laws regarding Maternal Substance use • To identify service needs specific to families/mothers and infants born after intrauterine exposure to substances • To develop in collaboration with the family and formal support systems a Plan of Safe Care (POSC) to address mother’s needs from pregnancy throughout infant’s birth; and to address infants needs and ensure health and safety throughout their development

  3. The History • CAPTA – Child Abuse Prevention and Treatment Act • to provide funding for the prevention, identification, and treatment of child abuse and neglect • authorized the government to research possible strategies to reduce the occurrence of child abuse and neglect.

  4. From 1974 - 2016 This Act has been reauthorized many times over the years to ensure the safety and well-being of all infants – including those who are born substance-exposed. The most recent iteration requires that all substance-exposed infants have a Plan of Safe Care (POSC), which addresses their needs and those of their mother. In 2016, the signing of the Comprehensive Addiction and Recovery Act (CARA) into law further amended CAPTA requirements to ensure that Plans of Safe Care address the use of both legal and illegal drugs including medically assisted treatment or Opioid Treatment Programs.

  5. The goal is to ensure that the health care providers involved in the delivery or care of such infants; (1) notify child protective services; (2) develop a plan of safe care for the infant following their release from healthcare providers addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver,

  6. State Monitoring System • Information that must be included; • The number of infants identified • The number of such infants that a POSC was developed • The number for whom a referral was made for appropriate services for the infant and/or affected family or care giver.

  7. Virginia Law requires that all prenatal care providers screen pregnant women for substance use; all health care providers must report substance exposed newborns, and all hospitals must develop a discharge plan and refer postpartum substance-using women to the local community services board (Code of Virginia §63.2-1509)

  8. Why is it important for Home Visitors to understand POSC? Developmental delays Depression-anxiety- other mental health disorders Problem behavior health-risk behaviors

  9. These families are most often referred for home visiting services!

  10. Stay focused on the GOAL!

  11. Plan of Safe Care!

  12. It takes a team!

  13. What should be addressed on POSC? Prior to birth….

  14. Afterbirth…

  15. PREGNANT WOMEN RECEIVE PRIORITY TREATMENT!

  16. Opioid misuse during pregnancy; • Poor or no prenatal care • Increased risk of premature labor & spontaneous abortions • Interruption of maternal/fetal dyad • Low birth weight • SIDS/SUIDS

  17. “SIGNS & SYMPTOMS” “nodding” or sleeping irritability Poor concentration Ignoring visit anxiety

  18. Women receiving MAT may exhibit some of the same symptoms, to include: “baby blues” fatigue

  19. What should a Home Visitor look for? • Past history of substance use • IPV • Mood swings • Poor concentration • Risky behaviors • Unpredictable behavior • Chaos • Financial difficulties • Missed appointments • Conflicts with family/significant others

  20. Back to the POSC… infant’s needs • Medical follow-up • Nutritional needs • Early Intervention • Basic care items • Child care

  21. …family unit

  22. Informal support

  23. Formal Support

  24. Systems?

  25. Techniques to engage families

  26. Active listening • Attentiveness • Comfortable eye contact • Open body posture • Being seated next to them instead of across from them

  27. Rapport Building • Resist the urge to – • Trivialize the persons experiences • Belittle or dismiss the individuals feelings • Speak with a patronizing tone • Become “overly involved” and make decisions without individuals input

  28. Assess & Review POSC regularly! Update Plan & share with other providers as necessary

  29. “Lift up your eyes and see the good in the world, for we are people with an amazing capacity to do great good. And if only the minority choose to exercise this capacity to the smallest degree, oh how wondrous and sweet the deeds performed at but a few hands!” ― Richelle E. Goodrich, Slaying Dragons

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