42 - Familiarity of Plans of Safe Care for Substance-Exposed Dyads in a National Sample of Birthing Hospital Providers

Publication Number: 4041.42

Adrian J. Caiazzo, MassGeneral Hospital for Children, Boston, MA, United States; Julia Reddy, University of North Carolina School of Social Work, Chapel Hill, NC, United States; Margaret L. Sieger, University of Kansas School of Medicine, Kansas City, KS, United States; Sarah Bernstein, Massachusetts General Hospital, Brookline, MA, United States; Davida Schiff, Mass General Brigham for Children, Boston, MA, United States; Leah Schwartz, MassGeneral Hospital for Children, Boston, MA, United States

Background: Federal legislation requires Plans of Safe Care (POSC) for infants with prenatal substance exposure - individualized care plans addressing the health and treatment needs of infants and families. However, the law offers limited guidance on implementation, and states and other jurisdictions vary in the extent to which they provide policy guidance on applying these requirements. As a result, birthing hospitals play a central role in interpreting and operationalizing these requirements, yet national data describing POSC knowledge and approaches are limited.

Objective: To describe birthing hospital knowledge and implementation of POSC, and to characterize respondent- and hospital-level characteristics associated with POSC familiarity.

Design/Methods: This study was approved by the Mass General Brigham IRB. A cross-sectional survey was conducted between July 2023 and June 2024 and distributed via perinatal quality collaboratives, professional listservs, and hospital directories. The survey captured respondent and perceived hospital characteristics, POSC knowledge, and implementation strategies. One response per hospital was included. Descriptive statistics were used, and multivariable modified Poisson regression models assessed associations between respondent and hospital characteristics and familiarity of POSC practices.

Results: Among 217 responding hospitals across 43 states (Table 1), POSC familiarity varied - 43.8% of respondents were not at all familiar with whether institutional POSC protocols existed, whereas only 23.5% were very familiar, with no significant differences by respondent role. Among those with knowledge of how POSCs were created, 34% reported plans were developed at delivery and 34% reported plans were developed prenatally (Table 2). Most POSC-familiar respondents (69%) reported creating a POSC when substance use was disclosed or toxicology testing was positive, regardless of newborn physiology (e.g. symptoms of substance withdrawal). Adjusted models showed greater likelihood of familiarity when hospitals had a dedicated perinatal social worker, were located in the Northeast, and when respondents had more than 20 years of experience (Figure 1).

Conclusion(s): Knowledge of POSC among birthing hospital staff engaged in the care of infants with prenatal substance exposure was limited, with more than two-fifths of respondents lacking awareness of POSC. Limited POSC familiarity at birthing hospitals more than two decades after the enactment of federal legislation suggest missed opportunities for coordinated, family-centered care.

Table 1 - Respondent and Hospital Characteristics


Table 2 - Knowledge and Implementation of POSC
†Asked only of respondents who were somewhat or very familiar with POSCs

Figure 1 - Association Between Respondent and Hospital-Level Characteristics and Familiarity with Plans of Safe Care (Adjusted Analyses)
Forest plot is presented on the log scale. Results are from the adjusted dataset using Poisson regression with a log link. *p < 0.05, **p < 0.01. aRR = adjusted risk ratio; 95% confidence intervals are shown. Dashed line represents the null value (aRR = 1)