Places of delivery include hospitals, free standing birth centers and home births. Federal Child Abuse Prevention and Treatment Act (CAPTA) legislation requires health care providers involved in the delivery and care of “substance affected” infants to notify child welfare agency upon identification of the infant as “substance affected.” It is recommended that the provider explain to the mother why a notification is being made to child welfare (see NC DHHS POSC FAQ Hospital Handout), including the goals of a Plan of Safe Care, and how a notification may differ from a report of child maltreatment. In North Carolina, health care providers must notify the county child welfare agency when one or more of the following NC DHHS definitions are met:

  • Affected by Substance Abuse:
    1. The infant has a positive urine, meconium or cord segment drug screen with confirmatory testing in the context of other clinical concerns as identified by current evaluation and management standards.
    2. The infant's mother has had a medical evaluation, including history and physical, or behavioral health assessment indicative of an active substance use disorder, during the pregnancy or at time of birth.
  • Affected by Withdrawal Symptoms:
    • The infant manifests clinically relevant drug or alcohol withdrawal.
  • Affected by Fetal Alcohol Spectrum Disorder(s) (FASD):
    1. The infant is diagnosed with one of the following: Fetal Alcohol Syndrome (FAS)

      • Partial FAS (PFAS)
      • Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (NDPAE)
      • Alcohol-Related Birth Defects (ARBD)
      • Alcohol-Related Neurodevelopmental Disorder (ARND)


    2. The infant has known prenatal alcohol exposure when there are clinical concerns for the infant per current evaluation and management standards.

Place of Delivery resources:

NC Healthcare Association (NCHA) & NC DHHS letter
Plan of Safe Care Executive Summary
Plan of Safe Care FAQ Hospital patients
CMARC Referral for Plan of Safe Care
Perinatal Quality Collaborative of North Carolina (PQCNC)