Recent federal legislation has impacted North Carolina policies related to infants who may have been exposed to substances during pregnancy. The goal of the federal legislation and subsequent state policies are to support the health of the infant, mother and family. The intentions of North Carolina policies are:

  1. To include infants, children and families in the Plans of Safe Care.
  2. To support the health of the infant and mother, not to penalize the mother and family.
  3. To increase access to treatment and support for all women with a substance use disorder and their children. To provide access to appropriate screening and surveillance, assessment and intervention services for infants determined to be affected by substance abuse, withdrawal or Fetal Alcohol Spectrum Disorders (FASD).

Infant Plan of Safe Care

The Infant Plan of Safe Care is simply a referral of an identified infant to Care Management for At-Risk Children (CMARC) from Child Welfare, that includes services and linkages that the infant and family may benefit from.

  • Based on information known at intake and the services provided by CMARC, infant and family could benefit from the following:
  • Comprehensive health assessment to identify a child’s needs and plan of care, including Life Skills Progression.
  • Linkage to medical home and communication with primary care provider.
  • Services and education provided by CMARC care managers that are tailored to child and family needs and risk stratification guidelines.
  • Identify and coordinate care with community agencies/resources to meet the specific needs of the family. Please specify below:
    • Evidence-Based Parenting Programs
    • LME/MCO or mental health provider
    • Home visiting programs, if available.
    • Housing resources/Food resources (WIC, SNAP, food pantries).
    • Assistance with transportation.Identification of appropriate childcare resources.
    • Other

Screening for referral to Infant-Toddler Program through Early Intervention for infants with diagnosis of Neonatal Abstinence Syndrome or for infants with developmental concerns.

Assessment of family strengths and needs and how they influence the health and well-being of the child.


In response to the nation’s prescription drug and opioid epidemic, Congress passed the Comprehensive Addiction and Recovery Act of 2016 (CARA). Section 503 of CARA aims to help states address the effects of substance use disorders on infants and families by amending provisions of the Child Abuse Prevention and Treatment Act (CAPTA), first enacted in 1974, that are related to infants with prenatal substance exposure. Specifically, CAPTA tasked states with developing policies and procedures that require health care providers to notify the child protective services system if they are involved in the delivery and care of an infant born and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal substance exposure, or a Fetal Alcohol Spectrum Disorder. The recent legislation, CARA, expanded “substance exposure” to include both illegal and legal substances.

CARA requires states to define what population of infants and families are identified as “substance affected”, what a Plan of Safe Care is, and who is responsible for developing and monitoring the Plan of Safe Care. The NC Plan of Safe Care Interagency Collaborative (NC POSCIC), a group that was developed to draft the necessary responses of the federal requirements as well as ongoing monitoring, is made up of Department of Health and Human Services (DHHS)  Agencies, community agencies and subject matter experts.

Overall, NC's implementation of CARA is an effort to better link infants and families to services and resources. Pregnancy can be an opportunity for women and those close to them to change behaviors around alcohol and substance use. It is important for all providers to understand the complexity of a woman's social, environmental, mental and physical conditions in order to best provide support throughout pregnancy, in the postpartum period and throughout parenting. NC DHHS and the NC POSCIC will continue to strengthen partnerships in doing this work and strive towards improving systems of care.

Links related to federal legislation