PC2046: Plans of Safe Care: Perspectives of Birth Parents with Substance-exposed Infants

Background: Prenatal substance exposure impacts a growing number of families, with important ramifications for child and caregiver wellbeing. Federal legislation passed in 2016 mandates healthcare providers to notify child protective service (CPS) agencies and offer a comprehensive care plan for all infants born affected by prenatal substance use, including legal, prescribed medications. These “plans of safe care,” or POSC, aim to provide wrap-around services to support infants and families impacted by substance use. However, if implemented without specific protections against stigma and bias, POSC may exacerbate feelings of mistrust and deter engagement with services, with the potential to worsen existing racial disparities in CPS involvement and engagement in medication-assisted treatment (MAT) programs. In order to understand how best to support and empower birth parents who use substances, we examined birth parents’ perceptions and experiences regarding POSC, particularly as they relate to trust, agency, and acceptance, as well as their engagement in services offered and provided.

Methods: Qualitative interviews were conducted with birth parents who were offered a POSC in Philadelphia. Transcripts were analyzed with Atlas TI using an inductive, grounded theory approach to identify content themes.

Results: Fear of CPS involvement, guilt, and stigma were commonly associated with POSC. Several birth parents described lacking agency or control in prenatal and postnatal care decisions, including discussions around initiation of MAT. Despite acknowledgement that it was helpful to have information for resources in one place, parents expressed confusion regarding how to access services following discharge from the hospital. Finally, parents described the need for increased supports that prioritize keeping families together, especially for birth parents who are actively using substances (Table 1).

Conclusion: Plans of safe care aim to provide support and services for substance-exposed infants and birth parents, however stigma, confusion regarding next steps, and fear of CPS involvement undermine these goals. Health system efforts to increase engagement among this marginalized population should prioritize parents’ agency and trust through increased transparency. Findings can inform hospital leaders and policymakers in their efforts to improve outcomes for substance-exposed infants and their families.