A Policy Scan on Plans of Safe Care for Infants With Prenatal Substance Exposure

Since 2016, federal law has stipulated state child welfare agencies must maintain policies and procedures to address the needs of infants with prenatal substance exposure (PSE) and their caregivers through a plan of safe care (POSC) focused on health and substance use treatment. Research into the effects of POSC across states has been slow due to a lack of accounting of states' POSC policies. The current study documents the status and contents of states' POSC policies.

We used search terms related to POSC in Nexis Uni, a legal software, to identify state statutes and regulations in effect during spring or summer 2024. We used a mixed deductive-inductive content analysis approach to identify domains of interest of POSC policies. To overcome limits of the legal search, we additionally compiled states' reports to Congress that describe their POSC policies. We calculated an accessibility rating to characterize the extent to which each state's POSC policy was available for public inspection.

Every state except Illinois maintains some type of POSC policy, primarily in the form of an administrative manual, while only 18 states had enacted POSC statutes or regulations. Administrative manuals are not easily accessible to the public or clinicians. While statutes and regulations are publicly accessible, they are inconsistent regarding parts of the POSC "process" are codified. Thirty-one states had very low levels of accessibility of POSC policies.

Ensuring consistent and transparent intervention for families with PSE will require greater clarity in policies and additional policy implementation supports.