NYS CAPTA CARA Information & Resources

For additional information and resources to support the implementation of the federal CAPTA CARA regulation in New York State.


CAPTA CARA is a federal regulation requiring the creation of Plans of Safe Care (POSC) to support the health and safety of newborns affected by substance use and their families or caregivers. The provisions also require states to collect and report data on the number of substance affected newborns born annually. See 42 USC §§5106a(b)(2)(B)(iii) and 5106a(d)(18).

What is a Plan of Safe Care (POSC)?

A Plan of Safe Care (POSC) is a tool that can be used to support individuals or families impacted by substance use or taking medications to treat substance use disorders. The purpose of developing a POSC with a family is to ensure that families are receiving comprehensive support, care, and treatment that meets their needs.

A POSC is a document which identifies how a provider, family, and community can support the safety and well-being of the newborn and person who gave birth. A POSC should be personalized and can address basic needs, identify support systems, and create linkages to necessary services and/or community based organizations as appropriate.

A POSC should be developed for pregnant individuals who:

  • are diagnosed with a substance use disorder; or
  • are receiving medication for addiction treatment (MAT) for a substance use disorder; or
  • are under the care and supervision of a healthcare provider who has prescribed opioids

Types of healthcare or social services providers who may develop a POSC in collaboration with a pregnant person or their family include:

  • Obstetricians/Gynecologists
  • Nurse Practitioners
  • Physician Assistants
  • Midwives
  • Doulas
  • Primary Care Providers (PCPs)
  • Licensed Mental Health or Substance Use Treatment Providers
  • OASAS Certified Providers
  • Opioid Treatment Program (OTP) Providers
  • Social Workers
  • Case Managers
  • Credentialed Alcoholism & Substance Abuse Counselors (CASAC)
  • Hospital Discharge Planners
  • Home Visitors
  • Certified Peer Recovery Specialists/Advocates

Examples of acceptable Plans of Safe Care (POSC) Templates are available below:

To make this most effective, healthcare and social service providers are encouraged to note the existence of the POSC in the pregnant person’s electronic medical record (EMR) after obtaining the patient’s specific consent (42 CFR Part 2 Cover Page) and (42 CFR Part 2 Consent Form).

Pregnant individuals are also encouraged to bring the POSC with them to the hospital or birth center. Discharge instructions for families impacted by substance use should include a reference to following the POSC. For pregnant or birthing individuals affected by substance use who do not have a POSC, or if the existing POSC does not include services for the newborn, the post-birth discharge plan serves as the start of a POSC and should include a warm linkage to appropriate community-based supports, healthcare or other providers to further develop the POSC. This is consistent with 10 NYCRR 405.9(f), which requires hospitals to link patients impacted by substance use to appropriate services at discharge. For more information about this requirement, please see DAL 18-13.

Mandated Data Collection:

Under this new federal regulation, hospitals and birth centers must collect and provide to the state aggregate de-identified data reflecting the number of newborns who are:

  1. Substance affected (as opposed to exposed)
  2. Number of newborns affected by substance use for whom a POSC was developed previously or during their hospital stay; and
  3. Number of newborns for whom referrals were made for the POSC to be completed in the community after discharge.
  4. *Please note (2) and (3) are subsets of (1), and the only newborns who should be included in (1) are those affected by substance use**

Hospitals and birthing centers in NYS were informed of these new requirements via letter from the New York State Department of Health which can be found here here. This data must be reported on a quarterly basis through the, “New York State CAPTA Data Form to the Office of Children and Family Services (OCFS)” survey form in the Health Commerce System (HCS) Health Electronic Response Data System (HERDS). Infants born in one quarter but discharged in another quarter should be included in the report or the quarter they are discharged from the facility.

Newborns Affected by Substance Use:

Only newborns who fall into one or more of the following groups should be counted as "substance affected" and included in the total for question (1) on the data collection form:

  • Newborns who display symptoms of substance withdrawal and have a positive toxicology screen
  • Newborns who receive a diagnosis of Neonatal Abstinence Syndrome (NAS)
  • Newborns who receive a diagnosis of a Fetal Alcohol Spectrum Disorder (FASD)

Impact on Screening and Toxicology:

These federal provisions do not change recommended practices for substance use screening during pregnancy or delivery. The American College of Obstetricians and Gynecologists (ACOG) continues to recommend universal verbal screening for substance use during pregnancy; They do not recommend routine toxicology testing during pregnancy and delivery, or for the newborn.

Toxicology testing should only be performed when medically indicated as part of the work up for the pregnant individual and infant to determine the appropriate medical treatment. ACOG recommends for biologic testing that, “Before performing any test on the pregnant individual or neonate, including screening for the presence of illicit substances, informed consent should be obtained from the pregnant person or parent. This consent should include the medical indication for the test, information regarding the right to refusal and the possible outcome of positive test results.” Each hospital should develop policies and procedures for obtaining informed consent prior to substance use assessment, including whether consent will be obtained verbally or in writing. While a verbal consent may be sufficient for a verbal screening, written consent is recommended prior to toxicology testing. Suspicion of drug use, which can be influenced by implicit and explicit bias, is not a medical basis for toxicology testing. Research has shown that implicit bias can affect patient-physician interactions and relationships.

When there is reasonable cause, beyond substance use, to suspect a child is at risk of abuse or neglect, hospitals and birth centers should continue to follow existing policies and protocols for making a report to the Statewide Central Register for Child Abuse and Maltreatment (SCR). Substance use alone, whether disclosed through development of a POSC, self-report, screening, toxicology, medical record note, or newborn symptoms, is not evidence of child abuse or neglect.

Child Abuse Reporting:

When there is reasonable cause, beyond substance use, to suspect a child is at risk of abuse or maltreatment, hospitals and birth centers should continue to follow existing policies and protocols for making a report to the Statewide Central Register for Child Abuse and Maltreatment (SCR). Substance use alone, whether disclosed through development of a POSC, self-report, screening, toxicology, or newborn symptoms, is not evidence of child maltreatment.

Steps to Implementation

These flowcharts (linked below) which provide additional guidance in implementing these requirements.


A series of webinars is being offered to assist in the roll out of CAPTA CARA data collection and reporting, as well as the development of Plans of Safe Care. Additional information about each webinar, including a link to register will be posted on this site.

Dates for each webinar, as well as a link to register are provided below. All webinars will be recorded and saved to this site once completed.

  • Webinar 1: Introduction to CAPTA CARA - 12/2, 1:00 p.m. to 2:00 p.m.

    This webinar will serve as an introduction to the CAPTA CARA legislation. Participants will gain an understanding of the history and background of CAPTA CARA legislation. Topics will include legislative requirements, reporting expectations, balance of supporting rights of pregnant individuals and reporting requirements.

  • Webinar 2: CAPTA CARA Data Collection - 12/7, 11:00 a.m. to 12:00 p.m

    This webinar will focus on ensuring participants understand the data collection and reporting requirements for birthing facilities. This webinar will include definitions of required data collection fields, information on how to report to CAPTA CARA data, and the required frequency of data reporting

  • Webinar 3: CAPTA CARA Implicit Bias & Child Welfare Reporting - 12/16, 11:00 a.m. to 12:00 p.m.

    This webinar will help participants to understand how implicit bias manifests and can impact the experience of care for clients (esp. people of color) and contribute to disparities in referrals for child welfare services. Participants will understand what implicit bias his, how to recognize the impact of bias on decision making, and steps to take to mitigate bias in healthcare settings.

  • Webinar 4: CAPTA CARA: Developing Plans of Safe Care - 12/21 12:00 p.m. to 1:00 p.m.

    This webinar will focus on supporting providers, especially those working in obstetrics and/or family practice in the development of Plans of Safe Care (POSC). Participants will understand the steps to creating an adequate POSC, how to assess POSCs that patients may have already worked to develop, and how to connect with substance use and other community providers to support patients upon discharge.

Additional Resources: