Individualized plan of safe/supportive care

A plan of safe/supportive care (POSC) is established for infants and family members affected by opioid and other substance use during pregnancy. A POSC involves various entities, including medical and clinical staff, delivery hospitals, and public health agencies, to collaborate, develop, update, implement, and monitor recovery and clinical care for infants and family members affected by opioid use during pregnancy. Ideally, the POSC is shared with the families and is initiated during the prenatal period or at delivery to support the family and care providers through the continuum of care. There is a role for child welfare agencies, the parent-child dyad, and making treatment referrals for the family/birth parent and newborn when needed. A POSC is also designed to help states support the continuum of care.

This plan can be a formal or informal document (ie, note to social worker, written document owned by birth parent/caregiver, etc). A hospital/practice should define what constitutes a plan of safe discharge/care. It is typically updated more frequently in the first year after delivery, although the recommended clinical care and community services offered are individualized for the specific needs of each family. The POSC presents an opportunity for pediatricians and other providers to support quality care and services focused on recovery and infant well-being.

The primary care pediatrician can ensure the plan is in the patient’s chart and if not, reach out to obtain the plan. If a plan does not exist, members of the pediatric practice can create a plan. The plan is typically updated more frequently in the first year after delivery.

All infants exposed to opioids prenatally need a plan of safe care (POSC) per the Child Abuse Prevention and Treatment Act (CAPTA). Each state is charged with developing, updating, implementing, and monitoring plans of safe care. Therefore, it is important for pediatricians to know and understand their states’ applicable policies, processes, and expectations. For more information on creating a plan of safe/supportive care, see the AAP publication Substance Use During Pregnancy and Plans of Safe Care (POSC): Implications for Pediatricians, Mothers, and Infants.