Helping parents and babies get the care they need
A Plan of Safe Care connects a baby exposed to substances before birth, and the baby’s parents, with treatment, health care, and support. Every state does this a little differently. Here you will find plain-language information, what is happening in your state, and what the research shows.
What is a Plan of Safe Care?
A Plan of Safe Care is a plan for an infant who was affected by substance use before birth, and for that infant’s parents or caregivers. It lays out the services and supports the family needs after the baby goes home, such as substance use treatment, health care, and help with parenting.
The requirement comes from the federal Child Abuse Prevention and Treatment Act (CAPTA). States that accept CAPTA funding must give the federal government an assurance, signed by the governor, that they have policies in place to identify these infants, notify child protective services, and develop a plan for each one.
- 1IdentifyRecognize infants born affected by substance use, withdrawal symptoms from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder.
- 2NotifyHealth care providers involved in the infant’s delivery or care notify the child protective services system.
- 3PlanDevelop a Plan of Safe Care that addresses the health and substance use disorder treatment needs of the infant and the family or caregiver.
- 4Monitor and reportTrack whether local agencies refer families to services and deliver them, and report annual counts to the federal government.
A notification is not a report of abuse
Federal guidance treats a notification to child protective services as a way to connect the family to support. On its own, a notification is not a finding of child abuse or neglect.
States decide the details
Federal law leaves most of the design to states: which infants qualify, who creates the plan, whether child protective services opens a case, and which agency follows up. As a result, a family’s experience can look very different from one state to the next.
How the policy developed
Plans of Safe Care have been part of federal law for more than twenty years. The 2016 amendments broadened who is covered and made families, not only infants, part of the plan.
CAPTA enacted
Congress creates federal funding for state efforts to prevent, investigate, and respond to child abuse and neglect.
Plans of Safe Care first required
States must have policies to notify child protective services about infants affected by illegal substance abuse or withdrawal, and to develop a plan of safe care for those infants.
Fetal Alcohol Spectrum Disorder added
The CAPTA reauthorization extends the requirement to infants affected by a Fetal Alcohol Spectrum Disorder.
Comprehensive Addiction and Recovery Act (CARA)
Section 503 of CARA removes the word “illegal,” so the requirement covers all substances, including prescribed medications. Plans must now address the needs of the family or caregiver as well as the infant, and states must monitor services and report data.
National data collection begins
States begin reporting, through the National Child Abuse and Neglect Data System, how many affected infants were identified, how many received a plan, and how many were referred to services.
What’s happening in my state
Every state meets the federal requirement in its own way. Choose a state to see how its Plan of Safe Care process works, what it is called, and how the state handles reporting during pregnancy and after birth.
Approach categories reflect state policy as of 2024. Source: Lloyd Sieger, M., Loch, S. F., Andraka-Christou, B., Stein, B. D., Levine, P., Caton, L., & Patrick, S. W. (2026). A taxonomy of states’ approaches to plans of safe care. Child Abuse & Neglect, 178, 108169. https://doi.org/10.1016/j.chiabu.2026.108169
State approaches reflect policy as of 2024 and are classified using the taxonomy in Lloyd Sieger et al. (2026). Other details are based on a review of state statutes, regulations, and federally required child welfare reports (Annual Progress and Services Reports) through 2024. Information on reporting exemptions for medication for opioid use disorder comes from If/When/How: Lawyering for Reproductive Justice, Prenatal Drug Exposure: CAPTA Reporting Requirements for Medical Professionals (current as of June 2025). Information on the purpose of required reports comes from the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Policy Information System, Pregnancy and Alcohol: Reporting Requirements. State policies change. If you know of an update for your state, please email msieger@kumc.edu.
What the research means
Key takeaways from our studies, written for the people who make, carry out, and live with these policies.
For policymakers
State leaders, legislators, and agency administrators
- Put the policy where people can find it.
Only 18 states have their Plan of Safe Care process in statute or regulation. In 31 states, the policy is very hard for clinicians or families to locate.
Hospital Pediatrics, 2025 - Decide whether a plan should require contact with child protective services.
Federal law intended plans to connect families to health care and treatment. Yet in 80% of states, a family can get a plan only after a report to or investigation by child protective services.
Child Abuse & Neglect, 2026 - Use “notify,” not “report.”
CAPTA asks providers to notify child protective services. In a 2019 review, 40 states used the word “report” and required an investigation, which can pull families into the system who do not need it.
Children and Youth Services Review, 2019 - Look at approaches outside child welfare.
After Connecticut moved to a deidentified notification and plans developed by health care and community providers, reports to child protective services and foster care placements for these infants went down.
Health Affairs, 2025 · Hospital Pediatrics, 2022 - Fund the work across systems.
Child welfare staff describe vague policy, hard-to-coordinate partners, and gaps in knowledge about substance use disorder. Clear roles and shared accountability with hospitals and treatment providers would help.
Child Welfare, 2023 · Families in Society, 2018 - Fix how these families are counted.
National child welfare data do not clearly identify infants with prenatal substance exposure, and report rates vary widely by state. Better data are needed to know whether policies are working.
International Journal of Drug Policy, 2024 · New England Journal of Medicine, 2021
For practitioners
Clinicians, hospital social workers, treatment providers, and child welfare staff
- Learn your state’s approach.
Many professionals have never heard of the CAPTA requirements. Use the state map above to see who develops the plan in your state and when.
Families in Society, 2018 · Child Abuse & Neglect, 2026 - A notification is not a finding of abuse or neglect.
Substance exposure alone does not mean a child is unsafe. Federal guidance treats notification as a way to connect families to services.
New England Journal of Medicine, 2021 · Children and Youth Services Review, 2019 - Screen every patient the same way.
In Connecticut, mothers of all races reported similar rates of substance use in pregnancy, but hospitals notified for Black mothers at twice the rate of White or Hispanic mothers. Testing only some patients may contribute to this gap.
Maternal and Child Health Journal, 2024 · Hospital Pediatrics, 2022 - Start the plan during pregnancy when you can.
A plan developed before birth gives the family time to connect with treatment and services before the hospital stay.
Child Welfare, 2023 · Infant and Child Development, 2022 - Make every plan complete.
Plans should cover the parent’s health and treatment needs as well as the infant’s. In Connecticut, plans were widely made but uneven in what they included.
Child Welfare, 2023 - Families with several exposures may need more support.
Each additional substance was linked to 2.5 times higher odds of a maltreatment report. These families may benefit from more intensive treatment and follow-up.
Families in Society, 2024
For parents and families
Pregnant people, new parents, and the people who support them
- A Plan of Safe Care is meant to help.
It lists the care and support you and your baby need after birth, such as substance use treatment, health care, and help with parenting.
- How it works depends on your state.
In some states, a doctor, nurse, or counselor makes the plan with you. In others, child protective services is involved. Use the state map above to see how your state does it.
Child Abuse & Neglect, 2026 - Medication for opioid use disorder is treatment.
In many states, taking methadone or buprenorphine as prescribed does not on its own require a report. Check your state on the map, and talk with your prescriber.
- You can ask to start a plan before your baby is born.
Ask your prenatal care provider or treatment program whether they can help you make a plan during pregnancy.
Child Welfare, 2023 - A notification is not a finding of abuse.
If the hospital notifies child protective services, that alone does not mean you have been found to have harmed your child.
- It is okay to ask questions.
You can ask who will see your plan, who will follow up, and what happens next. If you have questions about your rights, a lawyer or family advocate can help.
This information is for education. It is not legal or medical advice.
Research
Our work looks at how states put Plans of Safe Care into practice, how those choices involve child protective services and health care systems, and what the policies mean for mothers and infants.
Current projects
Public Policy & Health for Substance-Exposed Infant-Mother Dyads
Principal Investigator: Margaret Lloyd Sieger, PhD, MS, Department of Population Health, University of Kansas School of Medicine. National Institute on Drug Abuse, June 2023 to June 2028.
In 2019, Connecticut became the only state where community providers develop plans with mothers without sharing their identifying information with child protective services. This study links three state administrative databases and follows mothers over time with a survey to test how these plans affect substance use treatment, child safety, and involvement with child protective services.
Improving Outcomes for Substance-Affected Families in the Child Welfare System
Principal Investigator: Stephen W. Patrick, MD, MPH, MS, Rollins School of Public Health, Emory University. National Institute on Drug Abuse, August 2023 to July 2028.
This study evaluates how states have put Plans of Safe Care into practice. It reviews state laws, regulations, and guidance to classify each state’s approach; tests whether state actions are linked to fewer infant foster care placements and fewer emergency department visits for injuries from abuse; and interviews caseworkers, judges, clinicians, and others about what helps or gets in the way of implementation.
Publications
15 peer-reviewed articles on Plans of Safe Care, CAPTA, and prenatal substance exposure. Work before 2020 is published under Margaret H. Lloyd.
Plans of Safe Care across the states
-
2026
A taxonomy of states’ approaches to plans of safe care
Sorts every state’s approach into five types based on how closely the plan is tied to child protective services. In 80% of states, families can get a plan only after a report to or investigation by child protective services.
Lloyd Sieger, M., Loch, S. F., Andraka-Christou, B., Stein, B. D., Levine, P., Caton, L., & Patrick, S. W. Child Abuse & Neglect, 178, 108169. doi:10.1016/j.chiabu.2026.108169
-
2025
A policy scan on plans of safe care for infants with prenatal substance exposure
Every state except Illinois had some kind of Plan of Safe Care policy in 2024, but only 18 states had put it in statute or regulation. In 31 states, the policy was very hard for the public or clinicians to find.
Lloyd Sieger, M., Andraka-Christou, B., Loch, S. F., Stein, B. D., Bouskill, K., & Patrick, S. W. Hospital Pediatrics, 15(12). doi:10.1542/hpeds.2025-008536
-
2023
“The problem’s bigger than we are”: Understanding how local factors influence child welfare responses to substance use in pregnancy, a qualitative study
Interviews with 18 state and county child welfare staff found that practice varied widely because of vague policy, difficulty working across systems, and limited knowledge of substance use disorder.
Loch, S. F., Muhar, A., Bouskill, K., Stein, B. D., Shi, Q., Bonnet, K., Schlundt, D., Lloyd Sieger, M., Parker, E., Orgel, C., & Patrick, S. W. Child Welfare, 101(2), 193–223.
-
2020
Variation in states’ implementation of CAPTA’s substance-exposed infants mandates: A policy diffusion analysis
Grouped states into four clusters by how fully they had adopted the 2016 requirements. Census region was the only factor linked to a state’s cluster, which suggests states follow their neighbors.
Lloyd Sieger, M. H., & Rebbe, R. Child Maltreatment. doi:10.1177/1077559520922313
-
2019
Planning for safe care or widening the net?: A review and analysis of 51 states’ CAPTA policies addressing substance-exposed infants
Compared 51 states’ policies with the 2016 federal law. Only two states were consistent in all five areas. Forty states used the word “report” instead of “notify” and required investigations.
Lloyd, M. H., Luczak, S., & Lew, S. Children and Youth Services Review, 99, 343–354. doi:10.1016/j.childyouth.2019.01.042
Connecticut’s Family Care Plan approach
-
2025
Connecticut’s novel prenatal substance exposure policy is associated with declining CPS reports and foster placements
After Connecticut began its deidentified notification policy in 2019, reports to child protective services per birth fell 7% per month, and the share of reports leading to foster care fell 4% per month.
Lloyd Sieger, M., Godoy, L., Moore, T. E., Nichols, C., Goldsborough, E. J., Chen, S., Terplan, M., Griffin, B. A., & Patrick, S. W. Health Affairs, 44(7), 821–829. doi:10.1377/hlthaff.2024.01160
-
2024
A comparison of two statewide datasets to understand population prevalence of substance use in pregnancy: Findings and considerations for policy & research
Three times as many mothers reported alcohol or drug use in pregnancy as hospitals identified through notifications. Self-reported use was similar across race groups, but hospitals notified for Black mothers at twice the rate of White or Hispanic mothers.
Lloyd Sieger, M., Morin, J. C., Budris, L. M., Sienna, M., Ostfeld-Johns, S., Hart, L., & Morosky, C. Maternal and Child Health Journal. doi:10.1007/s10995-024-03914-6
-
2024
Trends in prenatal polysubstance exposure
Sixteen percent of Connecticut notifications involved more than one substance. Each additional substance was linked to 2.5 times higher odds of a maltreatment report.
Nichols, C., & Lloyd Sieger, M. Families in Society. doi:10.1177/10443894231213795
-
2023
Family care plans for infants with prenatal substance exposure
Connecticut data from 2019 to 2021 showed that hospitals and treatment providers developed many Family Care Plans, but unevenly, so some families may not have received the support they needed.
Lloyd Sieger, M., Nichols, C., Chasnoff, I. J., Putnam-Hornstein, E., Patrick, S. W., & Copenhaver, M. Child Welfare, 101(2), 169–192.
-
2022
Novel implementation of state reporting policy for substance-exposed infants
In the first 28 months, hospitals submitted more than 4,700 notifications, about 8% of Connecticut births. More than half of infants were diverted from child protective services, and the type of substance was the strongest predictor of what happened at discharge.
Lloyd Sieger, M., Nichols, C., Chen, S., Sienna, M., & Sanders, M. Hospital Pediatrics, 12(10). doi:10.1542/hpeds.2022-006562
Reporting, foster care, and national trends
-
2024
U.S. state rates of newborns reported to child protection at birth for prenatal substance exposure
Rates of newborns reported to child protective services for prenatal substance exposure more than doubled from 2011 to 2019 and varied widely by state. Rates tracked diagnosed neonatal abstinence syndrome, not state reporting laws.
Rebbe, R., Lloyd Sieger, M., Reddy, J., & Prindle, J. International Journal of Drug Policy, 130, 104527.
-
2020
Neonatal abstinence syndrome and trends in infant foster care admissions
From 2005 to 2014, higher rates of neonatal abstinence syndrome were linked to more infants entering foster care only in states that already removed many infants because of parental drug use.
Lloyd Sieger, M. H., & Becker, J. Child Welfare, 98(3), 121–143.
-
2018
The policy to practice gap: Factors associated with practitioner knowledge of CAPTA 2010 mandates for identifying and intervening in cases of prenatal alcohol and drug exposure
A statewide survey of 259 social services professionals found that few knew about CAPTA. Professionals with fewer years in practice knew more about prenatal substance exposure.
Lloyd, M. H., Akin, B. A., Brook, J., & Chasnoff, I. J. Families in Society, 99(3), 232–243. doi:10.1177/1044389418785326
Policy commentary and theory
-
2022
Child Abuse Prevention and Treatment Act, family care plans and infants with prenatal substance exposure: Theoretical framework and directions for future research
Uses a model of health services use to explain how CAPTA could improve outcomes for parents and infants, and sets out questions for future research.
Lloyd Sieger, M. H., Nichols, C., & Chasnoff, I. J. Infant and Child Development, e2309. doi:10.1002/icd.2309
-
2021
The 2021 reauthorization of CAPTA: Letting public health lead
Shows that unclear federal terms and national data definitions make it hard to identify the infants CAPTA covers, and assesses how the 2021 Senate reauthorization bill would change the law, including letting public health agencies lead.
Lloyd Sieger, M. H., Rebbe, R., & Patrick, S. W. New England Journal of Medicine, 385(18), 1636–1639. doi:10.1056/NEJMp2111378
Resources
Guidance and reports from federal agencies and national organizations.
- HHS · SAMHSA and ACFNational Center on Substance Abuse and Child Welfare
Federal technical assistance on prenatal substance exposure, Plans of Safe Care, and state implementation.
- U.S. GAO · GAO-18-196Substance-Affected Infants
A 2018 federal review of state notification policies, plan requirements, and the help states wanted from HHS.
- If/When/How · 2025Prenatal Drug Exposure: CAPTA Reporting Requirements for Medical Professionals
A state-by-state guide to when health care providers must report prenatal substance exposure, including exemptions for prescribed medications.
- NIH · NIAAAAlcohol Policy Information System: Pregnancy and Alcohol Reporting Requirements
State-by-state data on whether and why health care providers must report alcohol use during pregnancy.
- LAPPA · 2022Substance Use During Pregnancy and Family Care Plans
A fact sheet from the Legislative Analysis and Public Policy Association on identifying and treating pregnant and postpartum women with substance use disorders, notification requirements, and family care plans.
- Casey Family ProgramsInfant Plans of Safe Care
An overview of how jurisdictions have designed and carried out Plans of Safe Care.
About
This site is maintained by Margaret Lloyd Sieger, PhD, MS, Associate Professor in the Department of Population Health at the University of Kansas School of Medicine. She is also a Certified Peer Specialist.
Her research focuses on policies and interventions for parents with substance use disorders who are involved with child welfare, especially pregnant mothers and families with infants and young children. She studies state policy on substance-exposed infants, family treatment courts, and how best practices are put in place. She has published more than 50 peer-reviewed articles.
Earlier work is published under the name Margaret H. Lloyd.
University of Kansas School of Medicine
Kansas City, Kansas msieger@kumc.edu