Usability and acceptability testing of a Plan of Safe Care in a mobile health platform.

Purpose: Women who are pregnant or parenting while recovering from substance use disorder (SUD) are at risk for insufficient recovery support. With the federal mandate, implementation has been left to each state for the Plan of Safe Care (POSC), leading to challenges in providing comprehensive care coordination and meeting federal reporting requirements. Methods: This research tests the usability and acceptability of a POSC platform, called SAFE4BOTH, which combines a mobile health (mHealth) app for use by mothers with substance use disorder (MSUD) with a web-based case management system for use by stakeholders to reduce the issue of fragmented postnatal maternal and infant care. The platform was designed to enable access to services, improve reporting task workflow, and assist in improving interactions between mothers and service providers.After applying a user-centered design approach, the usability and acceptability of the SAFE4BOTH platform were evaluated using focus groups, interviews, and a System Usability Scale (SUS). The evaluation involved four staff members from a Medication for Addiction Treatment clinic (comprising of three case management workers and one peer counselor), four state employees of the Delaware Division of Family Services, and 20 mothers with MSUD who had delivered infants in need of a POSC.Features tested in the SAFE4BOTH platform included a secure, web-based POSC, a contingency management-based reward system, a micro-learning library, a resources locator, a chat messaging and videoconferencing system, a directory for contact management, a QR code reader, use of an appointment compliance system engaging geofencing, and an enhanced calendar. Family services and treatment center staff accessed SAFE4BOTH from their laptops or tablets, and MSUD accessed SAFE4BOTH from their phones. Results: Family services staff, treatment center staff, and MSUD participants rated SAFE4BOTH as usable and acceptable with average System Usability Scale scores of 68.1 (SD 8.5), 92.5 (SD 11.73), and 78.4 (SD 12.5) (respectively). Conclusion: The platform was judged both usable and acceptable by all three target populations (family services staff, treatment center staff, and MSUD). Further studies are planned to explore the efficacy of longitudinally supporting the mother's recovery and the infant's healthy development.

Impact of Plans of Safe Care on Prenatally Substance Exposed Infants.

OBJECTIVE: To assess the impact of recent federal statute changes mandating child welfare-based Plan of Safe Care (POSC) supportive programming and community-based linkages to treatment providers, resources, and services for families of infants affected by prenatal substance exposure (IPSE). STUDY DESIGN: Retrospective review of Delaware's statewide child welfare case registry data for IPSE birth notifications and subsequent hotline reports for serious physical injury/fatality concerns from November 1, 2018-October 31, 2020. Abstracted variables included IPSE sex, substance exposure type, family characteristics (maternal personal child welfare history or mental health diagnosis, treatment engagement), and POSC referrals. RESULTS: Of 1436 IPSE, 1347 (93.8%) had POSC support. Most IPSE (67.2%) had exposure to single substance types prenatally. Nearly 90% avoided out-of-home placement. Nearly one-fourth of mothers delivered a prior IPSE; 40% of mothers had personal histories of childhood protective services involvement. Also, 43.5% of mothers and 9.1% of fathers were referred to community-based resources, including substance use, mental health treatment, parenting classes, and home visiting nursing. Nearly 58% of IPSE were referred for pediatric/developmental assessment. Notably, 0.82% (11 out of 1347) of IPSE with POSC sustained serious physical or fatal injury. CONCLUSIONS: POSC promote supportive, potentially protective linkages to community-based programming for IPSE and their families.

Factors Associated with Child-Welfare Involvement among Prenatally Substance-Exposed Infants.

OBJECTIVE: To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants. STUDY DESIGN: This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively. RESULTS: Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect. CONCLUSIONS: Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect.