Sec. 7065. Plans of safe care

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Section 105(a) of the Child Abuse Prevention and Treatment Act ( 42 U.S.C. 5106(a) ) is amended by adding at the end the following: The Secretary is authorized to make grants to States for the purpose of assisting child welfare agencies, social services agencies, substance use disorder treatment agencies, hospitals with labor and delivery units, medical staff, public health and mental health agencies, and maternal and child health agencies to facilitate collaboration in developing, updating, implementing, and monitoring plans of safe care described in section 106(b)(2)(B)(iii).

Section 112(a)(2) shall not apply to the program authorized under this paragraph. Of the amounts made available to carry out subparagraph (A), the Secretary shall reserve— no more than 3 percent for the purposes described in subparagraph (G); and up to 3 percent for grants to Indian Tribes and tribal organizations 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 and their families or caregivers, which to the extent practicable, shall be consistent with the uses of funds described under subparagraph (D).

The Secretary shall allot the amount made available to carry out subparagraph

(A)that remains after application of clause

(i)to each State that applies for such a grant, in an amount equal to the sum of— $500,000; and an amount that bears the same relationship to any funds made available to carry out subparagraph

(A)and remaining after application of clause (i), as the number of live births in the State in the previous calendar year bears to the number of live births in all States in such year. If the amount made available to carry out subparagraph

(A)is insufficient to satisfy the requirements of clause (ii), the Secretary shall ratably reduce each allotment to a State. A State desiring a grant under this paragraph shall submit an application to the Secretary at such time and in such manner as the Secretary may require. Such application shall include— a description of— the impact of substance use disorder in such State, including with respect to the substance or class of substances with the highest incidence of abuse in the previous year in such State, including— the prevalence of substance use disorder in such State; the aggregate rate of births in the State of infants affected by substance abuse or withdrawal symptoms or a fetal alcohol spectrum disorder (as determined by hospitals, insurance claims, claims submitted to the State Medicaid program, or other records), if available and to the extent practicable; and the number of infants identified, for whom a plan of safe care was developed, and for whom a referral was made for appropriate services, as reported under section 106(d)(18); the challenges the State faces in developing, implementing, and monitoring plans of safe care in accordance with section 106(b)(2)(B)(iii); the State’s lead agency for the grant program and how that agency will coordinate with relevant State entities and programs, including the child welfare agency, the substance use disorder treatment agency, hospitals with labor and delivery units, health care providers, the public health and mental health agencies, programs funded by the Substance Abuse and Mental Health Services Administration that provide substance use disorder treatment for women, the State Medicaid program, the State agency administering the block grant program under title V of the Social Security Act ( 42 U.S.C. 701 et seq.), the State agency administering the programs funded under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.), the maternal, infant, and early childhood home visiting program under section 511 of the Social Security Act ( 42 U.S.C. 711 ), the State judicial system, and other agencies, as determined by the Secretary, and Indian Tribes and tribal organizations, as appropriate, to implement the activities under this paragraph; how the State will monitor local development and implementation of plans of safe care, in accordance with section 106(b)(2)(B)(iii)(II), including how the State will monitor to ensure plans of safe care address differences between substance use disorder and medically supervised substance use, including for the treatment of a substance use disorder; if applicable, how the State plans to utilize funding authorized under part E of title IV of the Social Security Act ( 42 U.S.C. 670 et seq.) to assist in carrying out any plan of safe care, including such funding authorized under section 471(e) of such Act (as in effect on October 1, 2018) for mental health and substance abuse prevention and treatment services and in-home parent skill-based programs and funding authorized under such section 472(j) (as in effect on October 1, 2018) for children with a parent in a licensed residential family-based treatment facility for substance abuse; and an assessment of the treatment and other services and programs available in the State to effectively carry out any plan of safe care developed, including identification of needed treatment, and other services and programs to ensure the well-being of young children and their families affected by substance use disorder, such as programs carried out under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.) and comprehensive early childhood development services and programs such as Head Start programs; a description of how the State plans to use funds for activities described in subparagraph

(D)for the purposes of ensuring State compliance with requirements under clauses

(ii)and

(iii)of section 106(b)(2)(B); and an assurance that the State will comply with requirements to refer a child identified as substance-exposed to early intervention services as required pursuant to a grant under part C of the Individuals with Disabilities Education Act ( 20 U.S.C. 1431 et seq.). Funds awarded to a State under this paragraph may be used for the following activities, which may be carried out by the State directly, or through grants or subgrants, contracts, or cooperative agreements: Improving State and local systems with respect to the development and implementation of plans of safe care, which— shall include parent and caregiver engagement, as required under section 106(b)(2)(B)(iii)(I), regarding available treatment and service options, which may include resources available for pregnant, perinatal, and postnatal women; and may include activities such as— developing policies, procedures, or protocols for the administration or development of evidence-based and validated screening tools for infants who may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder and pregnant, perinatal, and postnatal women whose infants may be affected by substance use withdrawal symptoms or a fetal alcohol spectrum disorder; improving assessments used to determine the needs of the infant and family; improving ongoing case management services; improving access to treatment services, which may be prior to the pregnant woman’s delivery date; and keeping families safely together when it is in the best interest of the child. Developing policies, procedures, or protocols in consultation and coordination with health professionals, public and private health facilities, and substance use disorder treatment agencies to ensure that— appropriate notification to child protective services is made in a timely manner, as required under section 106(b)(2)(B)(ii); a plan of safe care is in place, in accordance with section 106(b)(2)(B)(iii), before the infant is discharged from the birth or health care facility; and such health and related agency professionals are trained on how to follow such protocols and are aware of the supports that may be provided under a plan of safe care. Training health professionals and health system leaders, child welfare workers, substance use disorder treatment agencies, and other related professionals such as home visiting agency staff and law enforcement in relevant topics including— State mandatory reporting laws established under section 106(b)(2)(B)(i) and the referral and process requirements for notification to child protective services when child abuse or neglect reporting is not mandated; the co-occurrence of pregnancy and substance use disorder, and implications of prenatal exposure; the clinical guidance about treating substance use disorder in pregnant and postpartum women; appropriate screening and interventions for infants affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder and the requirements under section 106(b)(2)(B)(iii); and appropriate multigenerational strategies to address the mental health needs of the parent and child together. Establishing partnerships, agreements, or memoranda of understanding between the lead agency and other entities (including health professionals, health facilities, child welfare professionals, juvenile and family court judges, substance use and mental disorder treatment programs, early childhood education programs, maternal and child health and early intervention professionals (including home visiting providers), peer-to-peer recovery programs such as parent mentoring programs, and housing agencies) to facilitate the implementation of, and compliance with, section 106(b)(2) and clause

(ii)of this subparagraph, in areas which may include— developing a comprehensive, multi-disciplinary assessment and intervention process for infants, pregnant women, and their families who are affected by substance use disorder, withdrawal symptoms, or a fetal alcohol spectrum disorder, that includes meaningful engagement with and takes into account the unique needs of each family and addresses differences between medically supervised substance use, including for the treatment of substance use disorder, and substance use disorder; ensuring that treatment approaches for serving infants, pregnant women, and perinatal and postnatal women whose infants may be affected by substance use, withdrawal symptoms, or a fetal alcohol spectrum disorder, are designed to, where appropriate, keep infants with their mothers during both inpatient and outpatient treatment; and increasing access to all evidence-based medication-assisted treatment approved by the Food and Drug Administration, behavioral therapy, and counseling services for the treatment of substance use disorders, as appropriate. Developing and updating systems of technology for improved data collection and monitoring under section 106(b)(2)(B)(iii), including existing electronic medical records, to measure the outcomes achieved through the plans of safe care, including monitoring systems to meet the requirements of this Act and submission of performance measures. Each State that receives funds under this paragraph, for each year such funds are received, shall submit a report to the Secretary, disaggregated by geographic location, economic status, and major racial and ethnic groups, except that such disaggregation shall not be required if the results would reveal personally identifiable information on, with respect to infants identified under section 106(b)(2)(B)(ii)— the number who experienced removal associated with parental substance use; the number who experienced removal and subsequently are reunified with parents, and the length of time between such removal and reunification; the number who are referred to community providers without a child protection case; the number who receive services while in the care of their birth parents; the number who receive post-reunification services within 1 year after a reunification has occurred; and the number who experienced a return to out-of-home care within 1 year after reunification. The Secretary shall submit an annual report to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Education and the Workforce and the Committee on Appropriations of the House of Representatives that includes the information described in subparagraph

(E)and recommendations or observations on the challenges, successes, and lessons derived from implementation of the grant program. The Secretary shall use the amount reserved under subparagraph (B)(i)(I) to provide written guidance and technical assistance to support States in complying with and implementing this paragraph, which shall include— technical assistance, including programs of in-depth technical assistance, to additional States, territories, and Indian Tribes and tribal organizations in accordance with the substance-exposed infant initiative developed by the National Center on Substance Abuse and Child Welfare; guidance on the requirements of this Act with respect to infants born with and identified as being affected by substance use or withdrawal symptoms or fetal alcohol spectrum disorder, as described in clauses

(ii)and

(iii)of section 106(b)(2)(B), including by— enhancing States’ understanding of requirements and flexibilities under the law, including by clarifying key terms; addressing state-identified challenges with developing, implementing, and monitoring plans of safe care, including those reported under subparagraph (C)(i)(II); disseminating best practices on implementation of plans of safe care, on such topics as differential response, collaboration and coordination, and identification and delivery of services for different populations, while recognizing needs of different populations and varying community approaches across States; and helping States improve the long-term safety and well-being of young children and their families; supporting State efforts to develop information technology systems to manage plans of safe care; and preparing the Secretary’s report to Congress described in subparagraph (F). The authority under this paragraph shall sunset on September 30, 2023. . The Abandoned Infants Assistance Act of 1988 ( 42 U.S.C. 5117aa et seq.) is repealed.

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U.S. Code

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42 USC 5117aa

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Sec. 7065

Plans of safe care

Cite42 USC 5117aa

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