Reimagining "Plans of Safe Care:" Promoting Recovery, Family Well-being, and Engendering Trust through Family Care Planning

About This Grant

PROJECT SUMMARY Drug overdose accounts for approximately one-fifth of all pregnancy-associated deaths (the majority involving opioids) and drug-related foster care placements for infants have quadrupled over the past decade. Pregnant and parenting women with opioid use disorder (OUD) too often experience shame and stigma; punitive responses to prenatal substance use drive pregnant women away from care, creating major obstacles to receiving life-saving medications and engaging in treatment. To address the growing number of infants affected by prenatal substance exposure, the federal reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) requires a “Plan of Safe Care” (POSC) for parent-infant dyads affected by prenatal substance use at delivery. However, state implementation efforts have been varied, and few states have fully addressed all CAPTA requirements. Current approaches to meeting the POSC requirement, which rely on a static document created at delivery, do not provide adequate support for families struggling with custody issues and substance-related stigmas. The proposed study aims to adapt and evaluate the Family Care Planning (FCP) intervention, which implements longitudinal, transdisciplinary, and family-centered teleconference meetings to bring mothers together with their clinical, community, and child welfare teams to engage in facilitated, respectful treatment planning discussions. In the R61 Phase, we will refine and standardize protocols for the FCP approach using participatory co-design principles, incorporating input from early clinical adopters, mothers, community supports, and child welfare workers (Aim 1). We will also pilot test the FCP intervention to assess feasibility, fidelity, and acceptability (Aim 2). In the R33 Phase, we will conduct a stepped-wedge cluster randomized control clinical trial using a Hybrid Type 1 Effectiveness – Implementation study design with 312 parent-infant dyads. This phase will evaluate the effectiveness of FCP, implemented longitudinally over six months in the postpartum period, to increase maternal OUD treatment engagement and rates of family preservation. Additionally, we will explore the extent to which FCP improves substance use recovery, postpartum overdose rates, maternal self-efficacy, maternal mental health, and well-child care adherence. We will also explore measures of interpersonal (participants) and interagency (clinical-child welfare) trust. Finally, we will use the RE-AIM implementation framework and mixed methods to assess the extent to which FCP implementation is associated with effectiveness outcomes (Aim 4). Findings from this study are expected to have significant implications for addressing the effects of maternal substance use in the postpartum year.