II 

115TH CONGRESS 

2D SESSION S. 2696 

To provide grants to States to improve and coordinate their response to 

ensure the safety, permanency, and well-being of children at high risk 

for abuse and neglect. 

IN THE SENATE OF THE UNITED STATES 

APRIL 18, 2018 

Mr. CASEY introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide grants to States to improve and coordinate their 

response to ensure the safety, permanency, and wellbeing of children at high risk for abuse and neglect. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Supporting Infant 

5 Plans of Safe Care Implementation Act’’. 

6 SEC. 2. PLANS OF SAFE CARE. 

7 (a) IN GENERAL.—Title I of the Child Abuse Preven8 tion and Treatment Act (42 U.S.C. 5101 et seq.) is 

9 amended by inserting after section 107 the following: 


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1 ‘‘SEC. 107A. GRANTS TO STATES TO IMPROVE AND COORDI2 NATE THEIR RESPONSE TO ENSURE THE 

3 SAFETY, PERMANENCY, AND WELL-BEING OF 

4 INFANTS AFFECTED BY SUBSTANCE USE. 

5 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 

6 make grants to States for the purpose of assisting child 

7 welfare agencies, social services agencies, substance use 

8 disorder treatment agencies, public health agencies, and 

9 maternal and child health agencies to facilitate collabora10 tion in developing, updating, and implementing plans of 

11 safe care described in section 106(b)(2)(B)(iii). 

12 ‘‘(b) DISTRIBUTION OF FUNDS.— 

13 ‘‘(1) RESERVATIONS.—Of the amounts appro14 priated under subsection (h), the Secretary shall re15 serve— 

16 ‘‘(A) no more than 3 percent for the pur17 poses described in subsection (g); and 

18 ‘‘(B) up to 2 percent for grants to Indian 

19 Tribes and tribal organizations for purposes 

20 consistent with this section, as the Secretary 

21 determines appropriate. 

22 ‘‘(2) ALLOTMENTS TO STATES AND TERRI23 TORIES.—The Secretary shall allot the amount ap24 propriated under subsection (h) that remains after 

25 application of paragraph (1) on a competitive basis 

26 to States that apply for such a grant. 


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1 ‘‘(c) APPLICATION.—A State desiring a grant under 

2 this section shall submit an application to the Secretary 

3 at such time and in such manner as the Secretary may 

4 require. Such application shall include— 

5 ‘‘(1) a description of— 

6 ‘‘(A) the impact of substance use disorder 

7 in such State, including with respect to the sub8 stance or class of substances with the highest 

9 incidence of abuse in the previous year in such 

10 State, including— 

11 ‘‘(i) the prevalence of substance use 

12 disorder in such State; 

13 ‘‘(ii) the aggregate rate of births in 

14 the State of infants with prenatal sub15 stance exposure (as determined by hos16 pitals, insurance claims, claims submitted 

17 to the State Medicaid program, or other 

18 records), if available; and 

19 ‘‘(iii) the number of infants identified, 

20 for whom a plan of safe care was devel21 oped, and for whom a referral was made 

22 for appropriate services, as reported under 

23 section 106(d)(18); 


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1 ‘‘(B) the challenges the State faces in de2 veloping and implementing plans of safe care in 

3 accordance with section 106(b)(2)(B)(iii); 

4 ‘‘(C) the State’s lead agency for the grant 

5 program and how that agency will coordinate 

6 with relevant State entities and programs, in7 cluding the child welfare agency, the substance 

8 use disorder treatment agency, and the public 

9 health agency, programs funded by the Residen10 tial Treatment for Pregnant and Postpartum 

11 Women grant program of the Substance Abuse 

12 and Mental Health Services Administration, the 

13 State Medicaid program, the maternal, infant, 

14 and early childhood home visiting program 

15 under section 511 of the Social Security Act, 

16 the State judicial system, and other agencies, as 

17 determined by the Secretary; 

18 ‘‘(D) how the State will monitor local im19 plementation of plans of safe care, in accord20 ance with section 106(b)(2)(B)(iii)(II); 

21 ‘‘(E) how the State meets the requirements 

22 of section 1927 of the Public Health Service 

23 Act (42 U.S.C. 300x–27); 

24 ‘‘(F) how the State plans to utilize funding 

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1 cial Security Act (42 U.S.C. 670 et seq.) to as2 sist in carrying out any plan of safe care, in3 cluding such funding authorized under section 

4 471(e) of such Act (as in effect on October 1, 

5 2018) for mental health and substance abuse 

6 prevention and treatment services and in-home 

7 parent skill-based programs and funding au8 thorized under such section 472(j) (as in effect 

9 on October 1, 2018) for children with a parent 

10 in a licensed residential family-based treatment 

11 facility for substance abuse; and 

12 ‘‘(G) an assessment of the treatment and 

13 other services and programs available in the 

14 State, to effectively carry out any plan of safe 

15 care developed, including identification of need16 ed treatment, other services and programs to 

17 ensure the well-being of young children and 

18 their families affected by substance use dis19 order; 

20 ‘‘(2) a description of how the State plans to use 

21 funds for activities described in subsection (d) for 

22 the purposes of ensuring State compliance with re23 quirements under clauses (ii) and (iii) of section 

24 106(b)(2)(B); and 

25 ‘‘(3) an assurance that the State will— 


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1 ‘‘(A) comply with this Act and parts B and 

2 E of title IV of the Social Security Act (42 

3 U.S.C. 621 et seq.; 670 et seq.); and 

4 ‘‘(B) comply with requirements to refer a 

5 child identified as substance-exposed to early 

6 intervention services as required pursuant to a 

7 grant under part C of the Individuals with Dis8 abilities Education Act (20 U.S.C. 1431 et 

9 seq.). 

10 ‘‘(d) USES OF FUNDS.—Funds awarded to a State 

11 under this section may be used for the following activities, 

12 which may be carried out by the State directly, or through 

13 grants or subgrants, contracts, or cooperative agreements: 

14 ‘‘(1) Improving State and local systems with re15 spect to the development and implementation of 

16 plans of safe care, which— 

17 ‘‘(A) shall include parent and caregiver en18 gagement, as required under section 

19 106(b)(2)(B)(iii)(I), regarding available treat20 ment and service options, which may include re21 sources available for pregnant, perinatal, and 

22 postnatal women; and 

23 ‘‘(B) may include activities such as— 

24 ‘‘(i) developing policies, procedures, or 

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1 dence-based and validated screening tools 

2 for infants who may be affected by sub3 stance use withdrawal symptoms or a fetal 

4 alcohol spectrum disorder and pregnant, 

5 perinatal, and postnatal women whose in6 fants may be affected by substance use 

7 withdrawal symptoms or a fetal alcohol 

8 spectrum disorder; 

9 ‘‘(ii) improving assessments used to 

10 determine the needs of the infant and fam11 ily; 

12 ‘‘(iii) improving ongoing case manage13 ment services; and 

14 ‘‘(iv) improving access to treatment 

15 services, which may be prior to the preg16 nant woman’s due date. 

17 ‘‘(2) Developing policies, procedures, or proto18 cols in consultation and coordination with health 

19 professionals, public and private health facilities, 

20 and substance use disorder treatment agencies to en21 sure that— 

22 ‘‘(A) appropriate notification to child pro23 tective services is made in a timely manner; 


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1 ‘‘(B) a plan of safe care is in place, where 

2 needed, before the infant is discharged from the 

3 birth or health care facility; and 

4 ‘‘(C) such health and related agency pro5 fessionals are trained on how to follow such 

6 protocols and are aware of the supports that 

7 may be provided under a plan of safe care. 

8 ‘‘(3) Training health professionals and health 

9 system leaders, child welfare workers, substance use 

10 disorder treatment agencies, and other related pro11 fessionals such as home visiting agency staff and law 

12 enforcement in relevant topics including— 

13 ‘‘(A) State mandatory reporting laws and 

14 the referral and notification process; 

15 ‘‘(B) the co-occurrence of pregnancy and 

16 substance use disorder; 

17 ‘‘(C) the clinical guidance about treating 

18 substance use disorder in pregnant and post19 partum women; and 

20 ‘‘(D) appropriate screening and interven21 tions for infants affected by substance use dis22 order, withdrawal symptoms, or a fetal alcohol 

23 spectrum disorder and the requirements under 

24 section 106(b)(2)(B)(iii). 


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1 ‘‘(4) Establishing partnerships, agreements, or 

2 memoranda of understanding between the lead agen3 cy and health professionals, health facilities, child 

4 welfare professionals, substance use disorder and 

5 mental health disorder treatment programs, and ma6 ternal and child health and early intervention profes7 sionals, including home visiting providers, peer re8 covery specialists, and housing agencies to facilitate 

9 the implementation of, and compliance with section 

10 106(b)(2) and paragraph (2) of this subsection, in 

11 areas which may include— 

12 ‘‘(A) developing a comprehensive, multi13 disciplinary assessment and intervention process 

14 for infants and their families who are affected 

15 by substance use disorder, withdrawal symp16 toms, or a fetal alcohol spectrum disorder, that 

17 takes into account the unique needs of each 

18 family and addresses differences between legal, 

19 medically supervised substance use, and sub20 stance use disorder; 

21 ‘‘(B) ensuring that treatment approaches 

22 for serving infants, pregnant women, and 

23 perinatal and postnatal women whose infants 

24 may be affected by substance use, withdrawal 

25 symptoms, or a fetal alcohol spectrum disorder, 


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1 are designed to, where appropriate, keep infants 

2 with their mothers during both inpatient and 

3 outpatient treatment; and 

4 ‘‘(C) increasing access to appropriate evi5 dence-based medication assisted treatment serv6 ices for substance use disorders approved by the 

7 Food and Drug Administration and behavioral 

8 therapy, as appropriate, and counseling serv9 ices. 

10 ‘‘(5) Developing and updating systems of tech11 nology for improved data collection and monitoring 

12 under section 106(b)(2)(B)(iii), including existing 

13 electronic medical records, to measure the outcomes 

14 achieved through the plans of safe care, including 

15 monitoring systems to meet the requirements of this 

16 Act and submission of performance measures. 

17 ‘‘(e) REPORTING.—Each State that receives funds 

18 under this section, for each year such funds are received, 

19 shall submit a report to the Secretary, disaggregated by 

20 geographic location, economic status, and major racial and 

21 ethnic groups as determined by the State, on the following: 

22 ‘‘(1) The number of the infants identified under 

23 section 106(b)(2)(B)(ii) who experienced removal 

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1 unified with parents, and the length of time between 

2 such removal and reunification. 

3 ‘‘(2) The number of the infants identified under 

4 section 106(b)(2)(B)(ii) who experienced substan5 tiated reports of child abuse or neglect, received dif6 ferential response while in the care of their birth 

7 parents or within 1 year after a reunification has oc8 curred. 

9 ‘‘(3) The number of the infants identified under 

10 section 106(b)(2)(B)(ii) who experienced a return to 

11 out-of-home care within one year after reunification. 

12 ‘‘(f) SECRETARY’S REPORT TO CONGRESS.—The Sec13 retary shall submit an annual report to the Committee on 

14 Health, Education, Labor, and Pensions and the Com15 mittee on Appropriations of the Senate and the Committee 

16 on Education and the Workforce and the Committee on 

17 Appropriations of the House of Representatives that in18 cludes the information described in subsection (e) and rec19 ommendations or observations on the challenges, suc20 cesses, and lessons derived from implementation of the 

21 grant program. 

22 ‘‘(g) RESERVATION OF FUNDS.—The Secretary shall 

23 use the amount reserved under subsection (b)(1)(A) for 

24 the purposes of— 


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1 ‘‘(1) providing technical assistance, including 

2 programs of in-depth technical assistance, to addi3 tional States, territories, and Indian tribes in ac4 cordance with the substance-exposed infant initiative 

5 developed by the National Center on Substance 

6 Abuse and Child Welfare; 

7 ‘‘(2) issuing guidance on the requirements of 

8 this Act with respect to infants born with and identi9 fied as being affected by substance abuse or with10 drawal symptoms or fetal alcohol spectrum disorder, 

11 as described in clauses (ii) and (iii) of section 

12 106(b)(2)(B), including by— 

13 ‘‘(A) clarifying key terms; and 

14 ‘‘(B) disseminating best practices on im15 plementation of plans of safe care, on such top16 ics as differential response, collaboration and 

17 coordination, and identification and delivery of 

18 services, for different populations; 

19 ‘‘(3) supporting State efforts to develop infor20 mation technology systems to manage plans of safe 

21 care; and 

22 ‘‘(4) preparing the Secretary’s report to Con23 gress described in subsection (f). 

24 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—To 

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1 thorized to be appropriated $60,000,000 for each of fiscal 

2 years 2018 through 2024.’’. 

3 (b) DEFINITION.—Section 3 of the Child Abuse Pre4 vention and Treatment Act (42 U.S.C. 5101 note) is 

5 amended— 

6 (1) in paragraph (7), by striking ‘‘; and’’ and 

7 inserting a semicolon; 

8 (2) by redesignating paragraph (8) as para9 graph (9); and 

10 (3) by inserting after paragraph (7) the fol11 lowing: 

12 ‘‘(8) the term ‘substance use disorder’ means 

13 the abuse of alcohol or other drugs; and’’. 

Æ 


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