Despite current laws and efforts of state agencies and service organizations, the number of substance-exposed infant (SEI) cases reported to local departments of social services (LDSS) has more than doubled since 2009. This indicates a need for improving current strategies and developing new policies, practices, and programs to prevent and treat SEIs. As of July 2017, there are four SEI-related mandates in the Code of Virginia: Screening all pregnant women for substances, mandated reporter requirements, hospital referrals to the local Community Services Board (CSB) upon discharge, and developing a Plan of Safe Care when an SEI is identified.

In response to the growing crisis, the Virginia General Assembly passed House Bill 2162, sponsored by Delegate Todd Pillion during the 2017 session, which mandated the formation of a work group to identify barriers to the identification and treatment of SEIs and make recommendations to mitigate those barriers. The Virginia Department of Social Services Division of Family Services (VDSS) was assigned leadership of the work group charged with: (1) reviewing existing Virginia policies and practices and models from other states, and (2) developing legislative, budgetary, and policy recommendations for the elimination of barriers to treatment of SEIs in the Commonwealth.

VDSS leadership linked this study to work currently underway through the Three Branch Initiative (sponsored by the National Governor’s Association, National Conference of State Legislators, and Casey Family Programs) focused on finding solutions to prevent child fatalities for children under the age of four. This study also complements the substantial work undertaken by the Governor’s Task Force on Prescription Drug and Heroin Abuse established by Governor McAuliffe on September 26, 2014 through Executive Order 29.

Recommendations resulted from a multi-method approach to studying the issue over a four-month period to maximize inclusion and coverage of varying viewpoints. Between April and July 2017, there were four work group meetings, five regional town halls, and 134 responses to an online survey.(*2) An analysis of all documented comments revealed the consistent identification of the following barriers:

• Collaboration across disciplines and sectors occurs in some localities and regional areas, yet it is far from comprehensive in scope and coverage;

• Absence of a clear understanding of the breadth and totality of resources in the community and what other federal, state or local agencies do;

• Lack of consensus about Plans of Safe Care and other SEI-related mandates, particularly how they apply to specific agencies’ responsibilities;

• Limited data collection, and challenges with sharing what data is collected;

• Insufficient services for pregnant and postpartum women, particularly for long-term substance abuse interventions that encompasses the needs of the whole family; 

• Insufficient efforts to integrate the father and broader caregiver support system into prevention efforts; and,

• Lack of opportunities for multidisciplinary prenatal intervention.

The same analysis revealed the consistent identification of the following nine categories of recommendations:

• Multi-sector state, regional, and local partners can benefit from working together on this issue (e.g. forming multidisciplinary teams);

• Explore universal screening options (currently required under § 54.1-2403.1) and testing as methods to identify more substance-using pregnant women;

• Support a multidisciplinary approach during the prenatal period as the most effective intervention plan; 

• Improve the existing referral system between the hospitals and local CSBs as required by § 32.1-127(6);

• Identify data points to be collected (to include, but not limited to) annual reporting requirements mandated by the Child Abuse and Prevention Treatment Act (CAPTA), and a reliable data system to understand both the scope of the problem and the short- and long-term outcomes of interventions;

• Increase collaboration between LDSS, hospitals, adoption agencies, and other partners at the time of hospital discharge of the mother and/or infant so that all partners and support networks can be present to coordinate an approach. Integrate the Plan of Safe Care into the discharge plan and include family members and other caregivers in plan objectives;

• Support a trauma-informed approach to identification and treatment of SEIs and their full family and caregiver constellation; 

• Improve availability of home visiting programs to support pregnant women with a SUD and/or a SEI to ensure adherence to, and continuity of, the Plan of Safe Care; and,

• Improve workforce development options for LDSS, CSBs, and other private and community partners related to SEIs. Many professionals do not understand the complexity of the SEI issue.

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(*2) Meeting summary notes, attendance rosters, and survey data can be obtained through request to the VDSS Division of Family Services.