In November 2016, State Health Commissioner Dr. Marissa J. Levine declared the Virginia opioid addiction crisis a public health emergency. In 2017, the Governor and General Assembly directed the Secretary of Health and Human Resources to convene a workgroup to study barriers to the identification and treatment of substance-exposed infants (SEI) in the Commonwealth. In December 2017, the workgroup made recommendations in a report submitted to the General Assembly. The recommendations included:

• Identify a state agency to develop and implement a comprehensive plan to address substance-exposed infants;

• Identify a state agency with a recovery/treatment model to lead coordination of the development of a standardized Plan of Safe Care process;

• Develop a coordinated system of information sharing between agencies; and

• Formalize processes and systems of care across agencies and organizations, including memorandum of understandings (MOUs), screenings used, protocols, forms and referral processes.

Related to the workgroup’s recommendations, the Code of Virginia § 32.1-73.12 was amended during the 2018 General Assembly session to identify the Virginia Department of Health (VDH) as the lead agency to develop, coordinate, and implement a plan for services for substance-exposed infants. The plan must:

1. support a trauma-informed approach to the identification and treatment of substance-exposed infants and their caregivers and include options for improving screening and identification of substance-using pregnant women; and

2. include the use of multidisciplinary approaches in intervention and service delivery during the prenatal period and following the birth of the substance-exposed child, and in referrals among providers serving substance-exposed infants, their families and caregivers.

The General Assembly directed VDH to work cooperatively with the following stakeholders in developing the plan:

• Virginia Department of Social Services (DSS);

• Virginia Department of Behavioral Health and Developmental Services (DBHDS);

• Community Services Boards (CSBs) and Behavioral Health Authorities;

• Local Departments of Health;

• Virginia Chapter of the American Academy of Pediatrics (AAP);American College of Obstetricians and Gynecologists (ACOG), Virginia Section;

• Other stakeholders as may be appropriate.

Various state and local agencies, health systems, and community partners are involved in efforts to provide services and resources for SEI and their families. However, VDH identified a lack of coordination and knowledge of these efforts and resources among partners and health systems. Many partner organizations know what is available within their respective communities but this does not transcend to resources and services external to the community. In FY18, VDH conducted an environmental scan to capture efforts and resources currently available to pregnant and post-partum women and SEI across the Commonwealth. In FY19, VDH completed analysis of the survey results, and in FY20, VDH convened four different “pillar" workgroups to develop a statewide strategic plan for family and infants impacted by substance exposure and maternal substance use. The strategic plan, also known as the Pathways to Coordinated Care (PCC) Strategic Plan, is included in Appendix C. In FY21, the Commissioner of Health and the Secretary of Health and Human Resources reviewed and approved the PCC Strategic Plan. The PCC Strategic Plan is now the official Plan for Services for SEIs, and it will work in tandem with Virginia’s Maternal Health Strategic Plan, published in April 2021 (Appendix D), which seeks to eliminate the maternal health disparities and includes recommendations regarding maternal mental health and addressing social determinants of health.

This document fulfills the requirement for VDH to report annually regarding implementation of the plan.