Policy Implementation

Non-Punitive Approach to Substance Use in Pregnancy

State/Jurisdiction: New Mexico
Setting: Clinical
Population: Infant Women & Maternal
Topic Area: Access to Quality Healthcare Equity & Anti-Racism Mental Health & Substance Use Reproductive Health Birth Outcomes
NPMs: NPM 3: Risk-Appropriate Perinatal Care

This policy was developed in New Mexico in response to the federal CARA amendment to the federal CAPTA law that stated all state child welfare agencies are required to ensure every baby born exposed to substances receives a Plan of Care and that the numbers of babies receiving Plans of Care are reported to the Federal Agency. Because women (especially women of color) were reporting that they were receiving discriminatory treatment with regard to drug screening and treatment of substance use in pregnancy, New Mexico decided to go beyond just reporting numbers of care plans but to try to put in place systemic changes and training of hospital staff to provide a less stigmatizing, more equitable response. Led by the New Mexico Children, Youth and Families Department (CYFD) and the NM Department of Health (DOH), a task force consisting of healthcare providers, insurance care coordinators, state agency representatives, and other stakeholders has been working since September 2017 to articulate and implement New Mexico’s response to CARA. The task force has been building partnerships with health insurance providers, medical organizations, hospitals, and reproductive justice organizations to facilitate access to support services for expectant mothers, newborns, and their families struggling with addiction. These partnerships were critical in the ultimate success of the legislation. In January 2019, House Bill 230 was passed after much negotiation around language and many late nights testifying before legislative committees. This bill amended the Children’s Code in New Mexico to require hospitals to create the Plans of Care and send them to CYFD and DOH and to require insurance companies to provide care coordinators for this population. The legislation also stated that substance use in pregnancy should not, by itself, be considered a reason for a mandatory child abuse report.

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Implementation Handout
CARA Training

New Mexico Department of Health
Janis Gonzales, MD, MPH

Practice Website