Assistant professor, Department of Maternal and Child Health, Gillings School of Global Public Health and research scientist, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Director, Division of Child Welfare, Wake County Human Services, Raleigh, North Carolina.
N C Med J. 2022 Jan-Feb;83(1):67-74. doi: 10.18043/ncm.83.1.67.
The Comprehensive Addiction and Recovery Act (CARA) of 2016 amended the Child Abuse Prevention and Treatment Act (CAPTA), reinforcing and revising the requirement that states develop policies and procedures to address the needs of substance-affected infants and their caregivers. North Carolina's program, the North Carolina Plan of Safe Care (NC POSC), was implemented in August 2017 and involves coordination between multiple agencies. We conducted a quality improvement project to assess implementation of the North Carolina Plan of Safe Care in Wake County through interviews with key stakeholders involved in program delivery including health care providers (n = 7), child protective services social workers (CPS; n = 14), and care managers at Care Coordination for Children (CC4C; n = 10). We also analyzed data on Plan of Safe Care notifications to Wake County CPS from January 2018 to October 2019. Several key themes emerged in stakeholder interviews, including 1) lack of awareness of the program among health care providers; 2) gaps in information sharing and communication between agencies; 3) concerns regarding CPS notifications for all substance exposure types, including prenatal exposure to medication for opioid use disorder (MOUD); 4) common family needs and service referrals; 5) challenges engaging with families; 6) lack of knowledge among health care providers and CPS social workers regarding CC4C; and 7) benefits of the program for infants and families. From January 2018 to October 2019, 91% of notifications for substance-affected infants received by Wake County CPS as part of the NC POSC were screened-in for a maltreatment assessment. Of those screened-in, more than two-thirds (70%) involved prenatal marijuana exposure only. This project was limited to one county. As NC POSC implementation continues, further consideration of the infrastructure and guidance available to address the implementation challenges identified by stakeholders will be essential to meeting family needs and promoting infant safety and well-being.
2016 年的《全面成瘾和康复法案》（CARA）修订了《儿童虐待预防和治疗法案》（CAPTA），强化并修改了各州制定政策和程序以满足受物质影响的婴儿及其照顾者需求的要求。北卡罗来纳州的计划“北卡罗来纳安全护理计划”（NC POSC）于 2017 年 8 月实施，涉及多个机构的协调。我们通过对参与项目实施的主要利益相关者（包括医疗保健提供者（n=7）、儿童保护服务社会工作者（CPS；n=14）和 Care Coordination for Children（CC4C）的护理经理（n=10））进行访谈，评估了在威克县实施北卡罗来纳安全护理计划的情况。我们还分析了 2018 年 1 月至 2019 年 10 月威克县 CPS 收到的安全护理计划通知的数据。利益相关者访谈中出现了几个关键主题，包括 1）医疗保健提供者对该计划缺乏认识；2）机构之间信息共享和沟通存在差距；3）对所有物质暴露类型的 CPS 通知表示关注，包括产前接触治疗阿片类药物使用障碍（MOUD）的药物；4）常见的家庭需求和服务转介；5）与家庭建立联系的挑战；6）医疗保健提供者和 CPS 社会工作者对 CC4C 的了解有限；以及 7）该计划对婴儿和家庭的好处。2018 年 1 月至 2019 年 10 月，威克县 CPS 收到的作为 NC POSC 一部分的受物质影响婴儿通知中，91% 经筛选进入虐待评估。在筛选出的通知中，超过三分之二（70%）仅涉及产前大麻暴露。该项目仅限于一个县。随着 NC POSC 的实施继续进行，进一步考虑为解决利益相关者提出的实施挑战而提供的基础设施和指导，对于满足家庭需求和促进婴儿安全与健康将至关重要。
