Plan of Safe Care (POSC)
All infants exposed to opioids prenatally need a plan of safe care (POSC) per the Child Abuse Prevention and Treatment Act (CAPTA). A POSC requires various entities including medical and clinical staff, delivery hospitals, and public health agencies, to collaborate, develop, update, implement, and monitor recovery and care plans for infants and family members affected by substance use during pregnancy.
Regardless of a formal POSC being established, the task of coordinating multiple services for infants and birth parents, combined with an increased risk of adverse postdischarge outcomes, makes formalizing the discharge process critical. Pediatricians can communicate with the delivery team or the neonatologist to get information about every infant, and to build the clinical partnerships and collaborations.
Parents can own their plan of care and they should be supported to participate as active partners in all decisions about their infant’s care. Parents should also be encouraged to share the plan with other physicians and partners who support their health and recovery goals. The POSC should help forge transparent communication between families, caregiver, clinicians, community partners, and child welfare agencies.
Pediatricians have the authority to engage and collaborate with CPS to coordinate care for pregnant people and birth parents with OUD. Pediatricians should be familiar with their state regulations on accessing services available once a POSC has been developed. Answers to questions frequently asked by pediatricians about plans of safe care are available from the AAP (www.aap.org/nows).