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Brian Sandoval Julie Kotchevar, Ph.D.Governor Administrator
Richard Whitley, MS Ihsan Azzam, Ph.D., M.D.Director Chief
Medical Officer
Nevada’s CARA Plan of Care Department of Health and Human
Services Division of Public and Behavioral Health
SAPTA and Maternal and Child Health Program
Presented by: Judy DuMonte Date: August 2018
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Presentation Objectives
• Understand anticipated revisions to the Nevada Revised
Statutes (NRS) requiring healthcare providers to submit a CARA Plan
of Care for infants affected by illegal and legal perinatal
substance use.
• Understand what the CARA Plan of Care is and how it works.
• Substance Use Disorder Stigma
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What is the CARA Plan of Care? • In 2016, President Obama signed
the Comprehensive Addiction and Recovery Act (CARA) to address the
opioid epidemic.
• Requires health and human services providers to develop a plan
and provide treatment services to treat infants born with Neonatal
Abstinence Syndrome and their families.
• The Infant Plan of Safe Care for Nevada is called the CARA
Plan of Care.
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How it Works
Mom/Baby Identified Local or State CPS
Division of Public and Behavioral Health
Substance Use Treatment Providers
Birthing Facility/Providerdevelops
CARA Plan of Care
CARA Plan of Care Documented (electronically) Report generated
and sent
Determination of Investigation
Report screened out forinvestigation
Report screened in forinvestigation
CPS notifies reporting hospital and treatment
provider that there is noCPS involvement
Case closed refer to treatment provider
Case maintained open for in home or foster
placement
Data collected; Resources identified;
Audit plans
Summary reportprovided to DCFS for
federal reporting
Referral accepted;treatment documented and provided to DPBH
Partner with treatment provider on follow up
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CARA • The goal of CARA is NOT to remove children or punish
mothers for drug use but to ensure the child is safe and address
the health and substance use disorder treatment needs of both the
affected infant and family or caregiver.
• The CARA Plan of Care is meant to facilitate communication and
coordination among service providers to support the well-being of
the infant, as well as identify services for the caregiver(s).
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CARA Plan of Care A health care provider that delivers or
provides medical services to an infant in a medical facility and
who, in his or her professional occupational capacity, knows or has
reasonable cause to believe that the infant has been affected by a
fetal alcohol spectrum disorder or prenatal substance abuse or is
experiencing withdrawal symptoms resulting from in utero drug
exposure the medical facility shall ensure a Comprehensive
Addiction and Recovery Act (CARA) plan of care is in place prior to
or upon the infant’s discharge.
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CARA Plan of Care The Nevada CARA Plan of Care must ensure the
safety and well-being ofinfants following the release from the care
of healthcare providers, by:
1) address the health and substance use disorder treatment needs
of the infant and affected family or caregiver;
2) monitor the plans by the Division of Public and Behavioral
Health to determine whether and how local entities are making
referrals and delivering appropriate services to the infant and
affected family orcaregiver; and
3) Develop the Nevada CARA Plan of Care for infants affected by
any or all substances.
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e of Nevada 10lw ion of Publ ic and Bl!havior; I HH rh
CARA Plan of care Comprehensive Addict ion Recovery Act or
•CA.RA" Plan. of care must be developed with the fa mily/ ca
regiver and documented for all screened-intakes Identifying a
newborn as affected by substance(s}.
H'.ospital:
Name ttnd title of person completing form:
Section I Parent's Information: Mother's Information
Fi rst name:
Phone number: (
Street address:
Last name:
SSN: DOB:
City: I state: Zip: Ethnicity: H~panic/ L.atino
Race:
no Hispa nic/ Lati no c unknown or d id not report
o Blad:;/ African Americ.i n ative America n/ Alaska N'ative
Asian Wt'l.ite/ Caucasian ative Ha vaiian/P.acific Isla nd'e,
, Reiu.se to ldentify/Unkno~WI Race Multl racia
Education level: iJ Q.J rrently a , ends h igh :.diool [J High
school age does ,no attend [J High school dip loma/GEO complete ID
Enrolled in,college 1u Some college comple. ed o Associa,te Degree
attained a Bachelo.r's Degree or higher attained
Current ly employed ? Yes o No - If yes, pl ease note oocupatio
rn:
Phone number: I
Date completed:
(mm/ dd/yyyy)
County:
Annual housel.old inoome: u: Le~ tha n $10,000 c $:llO;OOO to
$20,000 . $20;00'1 to $30,000 $30;001 to $40,000 w $40;001 to
$50,000 More than $50,000
M.irital Status: o single (never mar,ried) marnied c: divorced
separated c: living tocether (not married) widowed Father' s
Informat ion
F'irst me: Last name:
Phone numbe r: ( SSN: DOB: (mm/d d/ vvvvl
c , Check here if add ress is same as mother's and skip o
Ethnicity question.
Street address:
City: I state: Zip : County: Ethnicity: n Hispa nic/Latino not
Hispanic/Lati no c: unknown or d id not report
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CARA Plan of Care Form
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Nevada CARA Plan of Care Form Components Infant’s Medical Care
Mother’s Substance Use & Mental Health • Prenatal exposure
history • Hospital care (NICU, length of stay, diagnosis)
• Other medical or developmental concerns • Pediatric care and
follow-up • Referral to Early Intervention and other services •
Other Mother’s Medical Care • Prenatal care history • Pregnancy
History • Other medical concerns • Screening and education •
Follow-up care with OB-GYN • Referral to other health care
services
Needs • Substance Use history • Mental Health history •
Treatment history • Medication assisted Treatment history •
Referrals for services
Family/Caregiver History and Needs • Family history • Living
arrangements • Parent-child relationships • Prior involvement with
child welfare • Current services • Other needed services • Child
safety and risk concerns
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Roles and Responsibilities The CARA Plan of Care form is
completed at the hospital prior to discharge by a social worker,
registered nurse, or other qualified hospital staff.
Upon completion, hospital staff perform the following tasks:
o Upload the completed CARA Plan of Care form into the
hospital’s electronic health record system (EHR)
o Submit the completed form to the Nevada DPBH and the local
child welfare agency
o Provide a copy of page 4 and 5 to the infant’s
family/caregivers
Follow-up will occur by the Nevada DPBH. The Perinatal Substance
Use Treatment Network and Women’s Services Coordinator will collect
the CARA Plan of Care forms to monitor plan of care
interventions.
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Sober Moms, Healthy Babies
Referral Resources sobermomshealthybabies.org The Sober Moms
Healthy Babies (SMHB) website is part of an effort launched by
Maternal and Child Health (MCH) Programs andthe Substance Abuse
Prevention and Treatment Agency (SAPTA). The SMHB website focuses
on preventing substance misuse during pregnancy and providing
women, their families, and providers information on resources and
treatment options. Nevada 211 nevada211.org Nevada 2-1-1, a program
of the Money Management International (MMI), is committed to
helping Nevadans connect with the services they need. Whether by
phone or internet, our goal is to present accurate, well-organized
and easy-to-find information fromstate and local health and human
services programs. Substance Abuse Prevention and Treatment Agency
(SAPTA) dpbh.nv.gov/Programs/ClinicalSAPTA/Home_-_SAPTA/ The
Substance Abuse Prevention & Treatment Agency (SAPTA)
administers programs and activities that provide
community-basedprevention and treatment. Home Visiting Resource
Directory
dpbh.nv.gov/Programs/MIECHV/dta/Publications/Nevada_Home_Visiting_(MIECHV)_-_Publications/
Nevada Home Visiting exists to develop and promote a state-wide
coordinated system of evidence-based home visiting to
supporthealthy child development. Community resources helpful to
families and young children have been compiled in this directory.
Mostare organized according to county or region of location;
however, please also see the statewide resources section for
additionalservices available.
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http:nevada211.orghttp:sobermomshealthybabies.org
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Thank you, Judy DuMonte
Perinatal Substance Use Treatment Network Nevada Department of
Health and Human Services Substance Abuse Prevention and Treatment
Agency
4126 Technology Way, Suite 200, Carson City, NV 89706 Telephone:
(775) 684-2217
Email: [email protected] Fax: 775-684-4185
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mailto:[email protected]
Nevada’s CARA Plan of CarePresentation ObjectivesWhat is the
CARA Plan of Care?How it WorksCARACARA Plan of CareCARA Plan of
CareCARA Plan of Care FormNevada CARA Plan of Care Form
ComponentsRoles and ResponsibilitiesReferral ResourcesThank
you,
