Chapin Hall

The Issue

The Child Abuse Prevention and Treatment Act (CAPTA), as amended by the Comprehensive Addiction and Recovery Act (CARA), requires states to ensure a Plan of Safe Care (POSC) is developed for families with infants affected by substance use before birth. This plan is voluntary and developed with a family to identify the support they need. When a POSC is developed, the healthcare provider notifies child welfare for federal reporting. That notification is not a maltreatment report: it includes no identifying information and does not require a child protection investigation.

Because states get little federal guidance or funding for these plans, their approaches vary widely, leaving providers without clear guidance on which families need a plan versus a maltreatment report, and inviting inconsistent, sometimes biased, decisions. That same confusion carries into notification: providers must notify child welfare of the POSC for federal reporting, a step meant to be distinct from a maltreatment report. But that is not always what happens in practice.

Plans of Safe Care are also often treated as one-time paperwork rather than an ongoing service plan, with little follow-up to ensure families connect with and benefit from services. Services and supports for these families are not systemically funded, and caregivers often don’t receive needed supports. States also track implementation differently, making it hard to see what is working.

The Evidence

• Infants under 1 are the most likely single age group to enter foster care, about 1 in 5 entries in FFY 2024. In FFY 2023, 52% of children under 1 entering out-of-home care had caretaker alcohol or drug use as a condition associated with removal (U.S. Department of Health and Human Services, 2025).
• Policies that define prenatal substance use as child abuse, or require reporting it to child protective services, are associated with lower rates of adequate prenatal and postpartum care and fewer provider referrals to treatment (Austin et al., 2022).
• Warm handoffs, when a provider connects a family directly to a service rather than sharing contact information alone, increase the likelihood that families receive that service.
• In Washington State, families without child safety concerns are connected to a community-based navigator, rather than being reported to child welfare by default.

The Way Forward

States and counties can and should build stronger Plans of Safe Care community pathways that connect families to support without automatically involving child welfare. Three steps leaders can take:

1. Review statute and guidance, current practice, public health, behavioral health, hospitals, early childhood programs, and people with lived experience to work through legal, funding, and fairness questions.
2. Build a cross-system team spanning child welfare, public health, behavioral health, hospitals, early childhood programs, and people with lived experience to work through legal, funding, and fairness questions.
3. Connect this work to existing strategies related to perinatal substance use, maternal and infant health, prevention, and child welfare already underway, rather than starting from scratch.

There are several funding vehicles states can use to pay for this work, including Title IV-E Prevention funds, Medicaid payments for peer support workers, and federal grants such as CAPTA and Temporary Assistance for Needy Families (TANF).

This guidance provides the foundation for states to design and build a Plans of Safe Care Community pathway that works as intended: a strong, voluntary, supportive pathway that keeps families safely connected to care.

For more information about this brief, contact Jenny Keefe.

Read the brief