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A Dyadic Framework of Care for Opioid-exposed Birthing Persons and Their Infants and Children
Shahla M Jilani1, Jonathan M Davis2, Matthew Grossman3
1Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Washington, DC.
Insights
Most US Department of Health and Human Services programs focus on the dyad of birthing persons with opioid use disorder (OUD) and their infants. This study developed a dyadic framework for integrated clinical care, surveillance, and research.
Area of Science:
- Public Health
- Maternal and Child Health
- Addiction Medicine
Background:
- Opioid use disorder (OUD) in birthing persons significantly impacts infant and child well-being.
- Existing health and supportive activities often address birthing persons or infants separately, not as a dyad.
- A unified framework is needed for comprehensive care, surveillance, and research for these families.
Purpose of the Study:
- To develop a dyadic-centered framework for clinical care, surveillance, and research.
- To analyze current US Department of Health and Human Services (HHS) activities serving birthing persons with OUD and their infants/children.
- To identify key characteristics of effective dyadic interventions.
Main Methods:
- Analysis of HHS activities from February-March 2023 (FY 2023-2024).
- Stratified activities by type and focus (dyad, birthing person, or infant).
- Descriptive and thematic analyses of 75 qualifying activities across eleven HHS agencies.
Main Results:
- 62% of 75 evaluated HHS activities focused on the dyad (birthing person with OUD and infant/child).
- Key dyadic activity categories included research (45%), education (28%), and health services (21%).
- Essential characteristics identified: life course approach, emphasis on relationships, dyadic outcomes, service wraparound, payment models, data linkage, and social determinants of health.
Conclusions:
- The majority of HHS programs demonstrate a dyadic focus for this population.
- Synthesizing identified elements enables a comprehensive dyadic framework.
- This framework integrates clinical care, public health surveillance, and research for improved outcomes.
Objective:
To develop a dyadic-centered framework focused on clinical care, surveillance, and research for birthing persons with opioid use disorder (OUD) and their infants and children.
Study Design:
Between February and March 2023, an analysis was conducted within the US Department of Health and Human Services (HHS) of activities directed at opioid-exposed birthing persons and their infants and children (the dyad) to identify: 1) number of activities, stratified by type and 2) characteristics across health and supportive activities that serve the dyad vs birthing persons or infants and children individually. Descriptive and thematic analyses were used to assess quantity and characteristics of fiscal year 2023-2024 activities aggregated across eleven HHS agencies.
Results:
Of 181 activities examined, 75 met inclusion criteria specific to serving birthing persons with OUD and opioid-exposed infants and children. Sixty-two percent of activities were dyad focused. Five categories of dyadic activities were identified: research (45%), education and training (28%), health and supportive services (21%), surveillance (4%), and quality improvement (2%). Eight specific characteristics were key to dyadic activities: a life course and generational approach, emphasis on relationship, dyadic outcomes, service wraparound, payment structures supporting dyadic care, data linkage, and social determinants of health.
Conclusions:
This analysis of HHS activities directed at birthing persons with OUD and opioid-exposed infants and children showed that most programs had a dyadic focus. Synthesizing elements identified from activities serving the dyad facilitated the development of a dyadic framework integrating clinical care, public health surveillance, and research.
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