Research In Practice Blog

Improving Support for Families Impacted by Perinatal Substance Use
Improving Support for Families Impacted by Perinatal Substance Use


Newer laws mandate notification of Child Protective Services (CPS) when infants are affected by perinatal substance use, withdrawal symptoms, or fetal alcohol spectrum disorder and that parents are offered a Plan of Safe Care (POSC). Implementation of these laws has varied across jurisdictions, and there is concern for how birth parents are faring amidst current practices. A team of researchers investigated maternal birth parents’ attitudes and experiences with POSCs in Philadelphia, PA, and salient themes and opportunities for program improvement emerged.  

Study design & findings

In-depth interviews were conducted with 12 birth parents of varying ages, races/ethnicities, and birth hospitals who had been offered a POSC. Themes that emerged included: appreciation for services; lack of agency and autonomy; and the need for better communication and individualized services. Additionally, many participants reported fear, stigma, shame, and/or confusion about CPS involvement, specifically related to the possibility of family separation after CPS notification of perinatal substance use.  

The research team gained insight into how POSC components and their surrounding processes might be improved or redesigned in consideration of a strengths-based, non-stigmatizing approach that incorporates harm-reduction principles. A definitive need for more supportive, wrap-around services and for mental health and parenting stress assistance was also identified.  


The results of this study suggest that better transparency, clarity of offerings, and a more person-centered approach may improve receptivity to POSC services.  As policymakers and practitioners consider iterating these services to better serve target populations, they should consider role and requirement of CPS involvement, improving care coordination and service accessibility, and focusing on a more compassionate approach.

Information & Resources

City of Philadelphia POSC Website 

Clinical Futures author(s):  

Barbara H Chaiyachati, MD, PhD; Meredith Matone, DrPH, MHS; Joanne N Wood, MD

Additional study author(s) from Children’s Hospital of Philadelphia:  

Yuan He, MD, MPH, MSHP; Shelley Bastos; Stacey Kallem, MD, MSHP


He Y, Chaiyachati BH, Matone M, et al. "Instead of just taking my baby, they could've actually given me a chance": Experiences with plans of safe care among birth parents impacted by perinatal substance use. Child Abuse Negl. Published online April 13, 2024. doi:10.1016/j.chiabu.2024.106798