The Baby Steps Program

....doing "Plans of Safe Care" right

For a number of years now, States have been required to identify substance-exposed newborns and work with their mothers and providers to create a “Plan of Safe Care” for the new family. The Comprehensive Addiction and Recovery Act of 2016 (CARA) expanded those requirements to encompass not only situations of exposure to illicit drugs but all substance exposure. The idea is that if a new mother has a substance use disorder, States should do all they can to assess her needs, make sure she is in treatment, and attend to any consequences that her child may have suffered due to the exposure.

Child Protective Services agencies have been on the front lines of carrying out this mandate, but CARA made the issue a little more complex. What does the agency do with a mother who is already in treatment for opioid use when she gives birth? How do you implement a plan of safe care for the family without necessarily turning the matter into a child abuse investigation?

In 2018, the National Quality Improvement Center for Collaborative Community Court Teams, a federally-funded initiative, issued a number of grants to states, local agencies, and tribes. Among the recipients was the Douglas County (Georgia) Juvenile Court, in collaboration with Georgia DFCS, the Administrative Office of the Courts, and others.

Led by now-retired Judge Peggy Walker, the collaborative created a program called “Baby Steps” to address maternal substance use even before birth. Working with recovery organizations, DFCS, OB-GYNs, and Family Treatment Courts, Judge Walker’s initiative worked to identify and assist pregnant women and new mothers in need of substance abuse treatment. Over the course of two years, the project enrolled 31 families (36 adults and 53 children) and provided plans of safe care to a total of 78 families.

The program has demonstrated success and continues beyond the original grant period. By voluntarily enrolling in the program, many of the new mothers avoided child protective services involvement. Successes of the program include a mother who had suffered a prior termination of parental rights on a prior child due to substance use. She was able to enroll in the program, demonstrate a commitment to recovery, and keep her newborn with her.

The program is completely voluntary but does work with women involved with DFCS or the Family Treatment Courts. These mothers and mothers-to-be “know they have issues, they know treatment is good for the child,” says Judge Walker. “But they need help making the connections to get into treatment.”

Especially with the advent of the Family First Prevention Services Act (FFPSA), the child welfare system has more tools to treat mothers and children affected by substance use disorder without bringing those children into the foster care system. FFPSA’s federal funds, for example, can be used to pay for mothers and children to be in residential substance treatment together. As Baby Steps coordinator Gabe Howard noted, by ensuring that mother and child can stay together, the program can enhance a newborn’s chances of successfully attaching to and bonding with the mother. That attachment is critical to the child’s successful emotional development.

If you’d like to learn more about Baby Steps, Georgia State University has worked with the collaborative to create a toolkit for those seeking to implement the program in other jurisdictions. If you’d like a copy, let me know!