Plans of Safe Care FAQs

Below are answers to commonly asked questions about Plans of Safe Care, notification of prenatal substance exposure, and making reports to child welfare for safety concerns. If you don’t find the information you need below, please contact us and we will do our best to answer your questions.

Plans of Safe Care basics

What is a Plan of Safe Care?

A Plan of Safe Care is a family centered plan designed to ensure the safety and well-being of an infant affected by prenatal substance exposure by addressing the immediate safety, health, and substance use treatment needs of the infant and affected family or caregiver. The Plan of Safe Care is developed in collaboration with the birthing parent and a multidisciplinary team to identify needs and connect the family to resources in the community. Best practice suggests that a Plan of Safe Care should be designed to meet both the short- and long-term needs of the family, with the goal of strengthening the family and keeping the child safely in the home.

The Colorado Plan of Safe Care template is available for download on the Plans of Safe Care resources and training page.

Why should a Plan of Safe Care be created?

Both federal and Colorado law require a Plan of Safe Care be offered and developed for all families impacted by prenatal substance exposure of a newborn, regardless of child welfare involvement. Additionally, Plans of Safe Care have been identified by Colorado policy, practitioner, community, and family stakeholders as a lever for improving cross-system care coordination and health outcomes for families impacted by perinatal SUD. Health care providers can work together with pregnant people and their families during the prenatal period to create a Plan of Safe Care and introduce services that can support the health and well-being of parent-infant dyads over the long term, proactively preventing child welfare involvement and setting families who are involved in child welfare on a trajectory of safety and well-being.

Who should receive a Plan of Safe Care in Colorado?

A Plan of Safe Care must be offered for any infant that is affected by in utero substance exposure, experiencing withdrawal symptoms, and/or diagnosed with a Fetal Alcohol Spectrum Disorder (FASD) regardless of whether or not a health care team determines that a report to child welfare is necessary. A Plan of Safe Care should be developed regardless of whether or not the exposure is to a legal or illicit substance.

When should a Plan of Safe Care be created?

State and Federal law require a Plan of Safe Care be offered and developed for any infant identified as being affected by prenatal substance exposure following their release from the care of a healthcare provider. However, state and national research have shown that Plans of Safe Care are more effective when done prenatally or as soon as prenatal substance use is identified. As such, Colorado best practice suggests that Plan of Safe Care be initiated prenatally or by the health-care provider at the birth hospital as part of the discharge process to ensure services are provided to the infant and the affected family/caregiver.

Who is involved in developing a Plan of Safe Care?

A Plan of Safe Care is developed with the birth parent and those involved in the support and treatment of the family. This may include:

• Family members
• Healthcare provider teams (including prenatal providers, addiction medicine specialists, pediatricians, neonatologists, and/or family medicine providers)
• Social workers
• Mental/behavioral health specialists
• Substance use treatment providers
• Child welfare professionals
• Support persons
• Peer support specialists

Who is responsible for ensuring the development of a Plan of Safe Care?

Child Welfare is the only entity legally required to ensure a Plan of Safe Care is developed for families impacted by perinatal substance use and involved in the child welfare system. Any other Plan of Safe Care development or coordination is voluntary.

Who might coordinate a Plan of Safe Care?

A Plan of Safe Care coordinator is simply the person who works with the woman/parent/caregiver on creating and maintaining a plan, and identifying and accessing desired resources. Any provider working with perinatal clients (including recovery coaches, case managers, home visitors, doulas, Early Intervention staff, treatment providers, medical providers, child welfare professionals, etc.) can serve as a Plan of Safe Care coordinator, provided they have the availability to meet regularly for a period of time with the client/patient and are equipped to make warm referrals to needed services.

What agency/entity is responsible for implementation of Plans of Safe Care in Colorado?

The Division of Child Welfare (DCW) at the CDHS Office of Children, Youth and Families is responsible for the statewide administration and oversight of Plans of Safe Care. By ensuring the development of a POSC for all infants identified as being affected by prenatal substance exposure, that addresses the safety, health, well-being and treatment needs of the family or caregiver for all substance exposed newborns, DCW seeks to:

• Decrease the number of referrals and open cases to child welfare when the Plan of Safe Care is utilized for all pregnant women and their families affected by substance use disorders before and during pregnancy by prevention and treatment services.
• Increase the utilization and integration of the Plan of Safe Care into child welfare practice and cross-system collaboration.
• Decrease length and severity of involvement for families involved in the child welfare system.
• Improve maternal and child health outcomes.

Recognizing that caring for infants and caregivers impacted by perinatal SUD requires diverse partnership and cross-system coordination, DCW has partnered with SuPPoRT Colorado to build a collaborative leadership structure for the statewide implementation of Plans of Safe Care. Colorado research shows Plans of Safe Care are most effective when developed prenatally or as soon as prenatal substance use is identified, often prior to child welfare involvement. As a response Colorado is investing in and developing strategies to support all families impacted by substance prenatal substance use. These strategies include prenatal Plans of Safe Care policies and practices that involve health and social services agencies outside of child welfare to support families for whom there are no identified concerns of child maltreatment. This approach may prevent referrals to child welfare that otherwise may have been reported.

Legislative changes affecting IEPS

What does IEPS stand for?

IEPS stands for Infant Exposed Prenatally to Substances.

While federal and state legislation use the term “substance exposed newborn,” whenever possible we strive to use and promote the use of person-centered  language. Using person-centered language when working with families impacted by substance use helps reduce stigma and bias and creates more supportive environments for open communication.

To learn more about using person-first language and the unique impact of stigma on pregnant people who use substances, read "Your Words Matter" on the National Institute on Drug Abuse website.

What are the key changes to federal legislation?

In 2016 Federal legislation changed requirements for State responsibilities for working with families impacted by prenatal substance exposure of a newborn. The two most impactful changes include:

• Expanded the population of who should receive a Plans of Safe Care. 
• Added a provision that states develop a process for health care providers involved in the delivery or care of infants born with, and identified as being affected by, substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a fetal alcohol spectrum disorder notify their local child protective services system.

What are the current federal requirements?

The Federal Comprehensive Addiction and Recovery Act (CARA) of 2016 built on previous legislation in 2003 and 2010 to expand state responsibilities regarding prenatally exposed infants and the needs of infants who are identified as affected by substance abuse, experiencing withdrawal symptoms, or having a diagnosis of fetal alcohol spectrum disorders (FASD). The CARA amended the Child Abuse and Prevention and Treatment Act (CAPTA) state plan to require that a Plan of Safe Care be developed for all infants identified as being affected by substances. A Plan of Safe Care must address not only the immediate safety needs of the affected infant, but also the health and substance use disorder treatment needs of the affected family or caregiver to ensure the safety and well-being of infants following the release from the health care provider.

CARA also included a requirement that states develop a process for health care providers involved in the delivery or care of infants identified as being prenatally exposed to substances, notify the child protective services system of the identification of the infant, however that notification should not constitute a report unless the definition of abuse and neglect is met (CAPTA 106(b)(2)(B)(ii)).

This federal legislation requires a state receiving Child Abuse Prevention and Treatment Act (CAPTA) grants develop a system to ensure and monitor the development of Plans of Safe Care across the state. This includes ensuring the family or caregiver is receiving the treatment and appropriate services required by the plan and the infant is safe and receiving appropriate care. Confirming the services identified in the Plan of Safe Care are implemented will ensure the ongoing health and substance use treatment needs of the infant and family are met. The Plan of Safe Care is updated as needed as additional needs and referrals for services are identified.

Source: Child Abuse Prevention and Treatment Act 106(b)(2)(B)(iii)

What are the changes to Colorado’s definition of abuse and neglect for substance-exposed newborns?

In 2020, the Colorado definition of child abuse and neglect for Substance Exposed Newborns changed. As a result, prenatal substance use is no longer automatically considered abuse or neglect. 

The previous definition defined abuse and neglect of prenatally substance exposed infants as “Any case in which a child tests positive at birth for either a schedule I controlled substance, as defined in section 18-18-203, C.R.S., or a schedule II controlled substance, as defined in section 18-18-204, C.R.S., unless the child tests positive for a scheduled II controlled Substance as a result of the mother’s lawful intake of such-substance as prescribed.”

As of June 30, 2020 "Abuse" or "child abuse or neglect" for infants prenatally exposed to substances was revised to: 

“Any case in which a child is born affected by alcohol or substance exposure except when taken as prescribed or recommended and monitored by a licensed healthcare provider, and the newborn child’s health or welfare is threatened by substance use,” (CRS 19-1-103(1)(a)(IV)).
Affected by alcohol or substance exposure is further defined as, “A child is born affected by alcohol or substance exposure when it impacts the child's physical, developmental, and/or behavioral response.” (7.000.2-A Definitions)

Threatened by substance use is defined as, “The newborn child’s health or welfare is threatened by substance use when the medical, physical, and/or developmental needs of the newborn child is likely to be inadequately met or likely unable to be met by parents and/or caregiver.” (7.000.2-A Definitions)

What is Colorado’s definition of Plans of Safe Care?

In 2022 Plans of Safe Care were defined in Colorado law as the following, “A plan of safe care is a collaborative process to create a documented plan for the health, safety, and well-being of an infant reported with prenatal substance exposure, following the infant's release from the care of a healthcare provider, and address the health, support, and substance use treatment needs of the affected family or caregiver(s) according to the requirements outlined in section 7.107.5 (12 ccr 2509-2)” (12 CCR 2509-1 7.000.2-A Definitions).”

Notification and reporting to child welfare

What is the new notification process?

When an infant is identified at birth as being prenatally exposed to substances, a notification should be made by the birthing hospital to Colorado Department of Human Services through the new IEPS Notification Form. As soon as possible after the birthing event and before discharge, a designated member of the care team should identify if a Plan of Safe Care has been developed prior to delivery. A Plan of Safe Care should then either be updated or developed with the caregiver. After updating/developing the Plan of Safe Care, a designated birthing facility care team member should  complete the non-identifying notification process via the IEPS Notification Form. After submitting the form, the care team member must complete a report to child welfare if prompted to do so. If a report to child welfare is not indicated, the care team should ensure warm referrals from the Plan of Safe Care are completed and provide a copy of the Plan of Safe Care to the family prior to discharge.

The Colorado Plan of Safe Care Hospital Workflow shows the decision-making process for notification and reporting.

Why the change?

Like most states, we have have not had a notification process separate from our reporting process for child abuse and neglect. Our approach to notification has been to use alternative response pathways (known as Differential Response) in which healthcare providers would call the CW hotline to make a report of an infant prenatally exposed to substances. CW staff collect information needed both for federal reporting and to evaluate the referral to determine if there was an allegation of abuse or neglect as defined by state law, and if further involvement assessment by child welfare is necessary.

However, State and National research has shown that developing a distinct notification process can help alleviate provider concerns about reporting infants and their families to child welfare when they have not identified child maltreatment concerns. A distinct process can also help reduce stigma by clarifying that not all prenatal substance exposure is a concern for child maltreatment. Lastly, developing a notification pathway may help reduce fear and promote access to healthcare and substance use treatment for birth parents.

What is the difference between an IEPS notification and a child welfare report?

A Child Welfare (CW) report or referral is made when there is a concern about child abuse or neglect.  In 2020, Colorado changed the definition of abuse and neglect for infants exposed prenatally to substance. Substance exposure of a newborn no longer requires an automatic report to child welfare for abuse/neglect (CRS 19-1-103(1)(a)(IV)).

As mandatory reporters, healthcare providers must make a report to child welfare when:

• There is any safety concern for any newborn; 
• Ongoing substance use by the parent creates concerns for the safety and well-being of the infant regardless of infant exposure;
• An infant was born affected by alcohol or substance exposure and the parent and/or caregivers are likely unable to meet the newborn child’s needs

County CW staff will evaluate the report to determine if there is an allegation of abuse or neglect as defined by state law, as well as if further involvement/assessment by child welfare is necessary. Only those concerns that allege child abuse and neglect are assessed further by a caseworker.

An IEPS Notification is made for all instances of infants exposed prenatally to substance (IEPS). It is not a report to child welfare and is not an indicator of child abuse or neglect. Notification is made even if a report to child welfare for concerns of abuse or neglect is not indicated. IEPS notification does not contain any personally identifying information about the family or infant.

When to report infant substance exposure to Colorado child welfare?

Providers and mandatory reporters must make reports to Child Welfare if:

• An infant has been affected by prenatal substance exposure AND there are safety concerns
• A healthcare provider identifies immediate safety concerns for the care of an infant that results from active substance use (illicit, prescribed, alcohol, etc.) by the parent and/or caregiver(s)
• Any other safety concerns exist for a newborn that are not related to substance use

Mandated Reporter requirements include a report or referral to child welfare within 12 hours of learning of suspicions of abuse or neglect.  If you have questions or concerns about a child's safety or well-being, please call the Colorado Child Abuse and Neglect Hotline 844-CO-4-Kids.

When should a notification be made?

A notification should be made for all infants identified as affected by prenatal substance exposure.  The notification should be made by the birthing hospital as soon as possible after the birthing event and before discharge. A notification is not a report to child welfare and is required even if a report to child welfare for concerns of abuse or neglect is not indicated.

Who makes a notification?

CDHS must ensure there are policies and procedures in place for healthcare providers involved in the delivery or care of infants prenatally exposed to substances to notify the State or local child welfare system (42 U.S.C. §§ 5106(b)(2)(B)(ii)).

Only one notification is required per child. A designated member of the infants provider team can complete the IEPS Notification process by entering the IEPS Notification Form. A designated person can be a hospital/birthing center provider, social worker, care coordinator, or similarly designated staff.

How do I complete a notification?

In Colorado, notification can now be done by filling out the Infants Exposed Prenatally to Substances (IEPS) Notification Form on the Plans of Safe Care page. Information collected in this form does not include identifying information about the infant or family. Data collected is aggregated and strictly used for required federal reporting and to inform quality improvement efforts by the Colorado Department of Human Services. Information will not be shared or used for any other purpose.

What infants require IEPS Notification?

• A newborn identified as being affected by prenatal substance use, or
• Newborn identified as experiencing withdrawal symptoms, or
• Newborn diagnosed with a Fetal Alcohol Spectrum Disorder

What substances are included and excluded in the notification?

All substances used by the birthing individual are to be considered for notification if the use of those substances results in 

• A newborn being identified as being affected by prenatally substances use, 
• A newborn experiencing withdrawal symptoms at birth, or
• A newborn displaying signs of a fetal alcohol spectrum disorder (FASD).  

In Colorado, this is true for legal, prescribed, and illicit substances. This includes substances used in Medication-Assisted Treatment (MAT) such as: methadone, buprenorphine, prescription opioids, and prescription benzodiazepines.

What about cannabis use?

Any in-utero exposure to cannabis constitutes meeting the requirement to submit a notification.

Is there a time frame for when the notification must be made?

It’s best practice for the notification to be made by the birthing hospital as soon as possible after the birthing event and before discharge.

Mandated Reporter requirements include a report or referral to child welfare within 12 hours of learning of suspicions of abuse or neglect.

What is the process for making an IEPS Notification?

A designated member of the infants hospital or birth center provider team can complete the IEPS Notification process by entering the IEPS Notification Form on the Plans of Safe Care page. Only one report per infant should be submitted.

What happens to the information?

The data collected through the notification process will go directly to and be housed by the Colorado Department of Human Services. Information will be aggregated and used for Federal reporting and State monitoring of the impact of federal and state requirements on racial and ethnic disparity across the state, and to inform quality improvement efforts and policy change.

What if I have more questions?

For questions specific to the Infants Prenatally Exposed to Substances (IEPS) Notification Form, email cdhs_IEPS@state.co.us.

For healthcare providers

What is required of healthcare providers?

As mandatory reporters, if a healthcare provider suspects child abuse or neglect, they are required by Colorado law to call 844-CO-4-KIDS or report the information to a local law enforcement agency. Find out more about being a mandatory reporter in Colorado and take the free virtual training.

Federal law requires states to ensure there is a process for notification to child welfare from health care providers involved in the delivery or care of all infants identified as being affected by prenatal substance use, demonstrating withdrawal symptoms resulting from prenatal substance exposure, or identified as having a fetal alcohol spectrum disorder.

When to report infant substance exposure to Colorado child welfare?

Providers and mandatory reporters must make reports to Child Welfare if:

• If an infant has been affected by prenatal substance exposure AND there are safety concerns
• If a healthcare provider identifies immediate safety concerns for the care of an infant that results from active substance use (illicit, prescribed, alcohol, etc.) by the parent and/or caregiver(s)
• A reminder- if any other safety concerns exist for a newborn that are not related to substance use, a report to child welfare is required. 

Mandated Reporter requirements include a report or referral to child welfare within 12 hours of learning of suspicions of abuse or neglect. If you have questions or concerns about a child's safety or well-being, please call the Colorado Child Abuse and Neglect Hotline 844-CO-4-Kids.

How can healthcare providers determine that there are no safety concerns (i.e., not “threatened by use”)?

Healthcare providers should assess whether risk factors impact the safety of the infant. If a healthcare provider has any concerns, they should call child welfare who can complete an in-depth screening and potentially open an assessment.

The following questions can help healthcare providers identify potential safety concerns:

• Is the parent actively participating in recovery?
• Is there evidence of ongoing substance use that impairs their ability to parent?
• How are the parents caring for and bonding with the infant? Can they console their infant?
• Does the infant require special care due to substance exposure or withdrawal?
• Can the parents meet the infant’s medical, physical and developmental
  needs?

This is not a complete listing of potential risk factors, but intended to aid providers. Healthcare providers are encouraged to call child welfare if they have any concerns about the safety of a family or newborn.

When to make a notification?

A notification is necessary for all infants identified as affected by prenatal substance exposure.  The notification must be made by the birthing hospital as soon as possible after the birthing event and before discharge. A notification is not a report to child welfare and is necessary even if a report to child welfare for concerns of abuse or neglect is not indicated.

What is the role of healthcare providers in Plans of Safe Care?

There are no legal requirements for healthcare providers related to Plans of Safe Care. However, in Colorado as a best practice we are asking health care providers to work together with pregnant people and their families to create a Plan of Safe Care prior to child welfare involvement. This may be during the prenatal period or as soon as prenatal substance use is identified. Prenatal Plans of Safe Care may increase access and engagement in substance use treatment and prenatal care, improve maternal and infant birth outcomes and reduce the number families referred to child protective services or the need for an ongoing open child welfare case.

If a family has a Plan of Safe Care, is a report to child welfare required?

A report to child welfare is required any time there are safety concerns related to an infant. This is true regardless of if a Plan of Safe Care has been developed. However, if a family has a Plan of Safe Care and there are no safety concerns then a report to child welfare is not needed.

If a family does not want to develop a Plan of Safe Care, is a report to child welfare required? 

A Plan of Safe Care is voluntary. A healthcare provider or other mandatory reporter is not required to make a report to child welfare if a family declines to complete a Plan of Safe Care, as long as there are no concerns for the safety and wellbeing of the infant.

Healthcare providers and other mandated reporters must call the Child Protective Services Hotline at DCW when safety concerns are present. This is true even if a family chooses to complete a Plan of Safe Care and there are still immediate safety concerns.

What if a family with a Plan of Safe Care is not following up with the referred services, does this need to be reported to DCW?

The services and referrals listed on a Plan of Safe Care are voluntary. A healthcare provider or other mandatory reporter is not required to make a report to child welfare simply because a family declines Plan of Safe Care services. However, healthcare providers and other mandated reporters must call the Child Protective Services Hotline at DCW when concerns of child abuse or neglect are present. If the family with a Plan of Safe Care does not engage in the services in the plan, the healthcare provider should assess whether the lack of follow-up creates a child safety concern. If so, as a mandated reporter, the provider should report those safety concerns to child welfare.

For child welfare

What is the role of Colorado’s Division of Child Welfare?

At the state level, the Division of Child Welfare has the administrative oversight and responsibility for ensuring policies and procedures are in place to address the needs of infants born with and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder through implementation of Plans of Safe Care. This includes ensuring the development and implementation of monitoring systems regarding the implementation of Plans of Safe Care.

What is the role of local child welfare agencies?

At the community level, the legal responsibility for developing a Plan of Safe Care ultimately rests with the child welfare agency. If child welfare receives and screens in a referral for concerns related to prenatal substance exposure, and a Plan of Safe Care has not been created by a medical, treatment or community provider, a child welfare caseworker must create a Plan of Safe Care in collaboration with parents, caregivers, medical providers, and others who may be a part of the plan (7.107.5).

What are the state-defined requirements for child welfare practice?

In 2022, Colorado updated State rule to provide Plan of Safe Care practice requirements for child welfare staff.  According to Volume 7 of the Colorado Code of Regulations:

• Child Abuse and Neglect Hotline staff are required to ask enhances screening questions when SEN is an identified referral reason (12 CCR 2509-2- 7.103.5(e)).
• Child welfare caseworkers are required to complete a Plan of Safe Care for all screened-in referrals with an allegation of SEN concerns if one has not already been created (12 CCR 2509-1 7.000.2(A) Definitions & 12 CCR 2509-2 7.1000 Referral and Assessment).
• The Colorado Plan of Safe Care must be completed with the parent/caregiver(s) and based on based on the interview or observation of the alleged victim child(ren) and in collaboration with medical providers and others who may be a part of the plan (12 CCR 2509-2- 7.104.12(K))
• A Plan of Safe Care must be entered into and approved in the statewide child welfare data system within 60 calendar days (12 CCR 2509-2- 7.104(D))

Source: CDHS Operation Memo: Plan of Safe Care Volume 7 - New Rule
 

What is Colorado’s definition of abuse and neglect for substance-exposed newborns?

As of June 30, 2020, "Abuse" or "child abuse or neglect" for infants prenatally exposed to substances was revised to: “Any case in which a child is born affected by alcohol or substance exposure except when taken as prescribed or recommended and monitored by a licensed healthcare provider, and the newborn child’s health or welfare is threatened by substance use,” (CRS 19-1-103(1)(a)(IV)).

Affected by alcohol or substance exposure is further defined as: “A child is born affected by alcohol or substance exposure when it impacts the child's physical, developmental, and/or behavioral response.” (7.000.2-A Definitions)

Threatened by substance use is defined as: “The newborn child’s health or welfare is threatened by substance use when the medical, physical, and/or developmental needs of the newborn child is likely to be inadequately met or likely unable to be met by parents and/or caregiver.” (7.000.2-A Definitions)

Source: CDHS Operation Memo: Substance Exposed Newborn definition of Abuse and Neglect & Child Protection Task Group

Where can child welfare professionals find more tools for using Plans of Safe Care and supporting families impacted by substance use?

Additional resources for child welfare professionals are detailed on the Child Protection and Prevention Team Resources page of the Child Welfare Training System website, under the Substance Use tab.